Risk scores Flashcards
What is a QRISK2 used to calculate?
Risk of MI or stroke in 10 years
What factors from a history are used to calculate QRISK2?
Age, gender, hypertension, diabetes, FHx of angina or MI in 1st degree relative Smoking, Chronic Kidney Disease: stage 4 or 5 Atrial Fibrillation Postcode, BMI, Systolic BP, Ethnicity, Cholesterol/ HDL level
What lifestyle advice should be offered to someone with a high QRISK2
Smoking cessation Diet Exercise Adherence to medication for diabetes & HTN Consider starting on statins and aspirin
What does CHADS2 Vasc calculate?
Risk of stroke in patients with AF
1 point= moderate risk
>2= high risk
What does CHADS2 Vasc stand for?
C= congestive cardiac failure H= hypertension A= age (>65= 1 point, >75= 2 points) D= diabets S2= stroke (previous) and sex (F>M)
Vasc= peripheral vascular disease
A CHADS2 Vasc score of 2 or above indicates high risk for AF related stroke, what treatment should be undertaken?
Anticoagulants= warfarin + NOACs (apixaban & rivaroxaban)
Anti-platelets= aspirin
A CHADS2 Vasc score of 1 indicates moderate risk of an AF related stroke, in this case you need to weigh up risks and benefits of treatment, what are these risks and benefits?
Warfarin:
negatives: daily INR, teratogenic, increased risk of bleeding
Positives: reversible
NOACs (apixaban and rivaroxaban)
Contraindicated in renal failure or GI bleeding
NONreversible + increased risk of bleeding
What does ABCD2 calculate?
Risk of a stroke after a TIA
What does ABCD2 stand for?
A= age (>60)
B= blood pressure (>140 systolic, >90 diastolic)
C= Clinical features of TIA
Speech disturbance & unilateral weakness
D2= Diabetes & duration of symptoms (>1 hour= 2 points, 10- 59 mins= 2 symptoms
In an ABCD2 score a patient with 6 or above is high risk,
between 3-5 is moderate risk and below 3 is low risk, how should a high risk patient be managed?
Antiplatelets= aspirin, clopidogrel
Statins= simvostatin
Lifestyle advice
What is the Wells criteria
assesses risk at presentation for DVT diagnosis
What factors from a history would be on wells criteria?
Bedridden, paralysis, immobilisation, history of DVTs, active cancer
oedema, swelling, tenderness, collateral veins, swelling of whole leg
DVT investigations?
Treatment?
lifestyle advice?
D Dimer test,
USS doppler
Low molecular weight heparin and anticoagulants
Smoking cessation, diet, exercise, Oral contraceptive increases risk
What does FRAX predict?
risk of fracture in 10 years (in patients with osteoporosis)
What factors from a history are used to calculate a frax score?
previous fracture, parental hip fracture, alcohol intake, secondary osteoporosis, current smoking, glucocorticoid use, rheumatoid arthritis, age, sex, weight, height, femoral neck bone mineral density (DEXA scan)
