Risk assessments Flashcards
What is the QRISK3 score used for?
Estimate the risk of developing a heart attack or stroke over the next 10 years
What information is used in a QRISK3 score?
Patient information:
- age
- sex
- ethnicity
- smoking status
- angina/MI in 1st degree relative < 60
Comorbidities:
- diabetes
- CKD (stage 3, 4, or, 5)
- AF
- migraines
- rheumatoid arthritis
- SLE
- severe mental illness
- erectile dysfunction
Medication:
- regular steroid
- blood pressure treatment
- atypical antipsychotic medication
Others:
- cholesterol/HDL ratio
- systolic blood pressure
- height & weight
How are patients with a QRISK3 score of less than 10% managed?
- Advise that their risk is low
- Offer relevant lifestyle factors
- Review relevant comorbidities
- Reassess in 5 years
How are patients with a QRISK3 score of more than 10% managed?
- Exclude familial hypercholesterolaemia and other causes of secondary dyslipidaemia
- Discuss the benefits of lifestyle modifications and optimal management of comorbidities
- Offer statin treatment if lifestyle modification is ineffective/inappropriate
- atorvastatin 20mg OD
What is a ABCD2 score used for?
Estimates the risk of stroke after a suspected TIA
What information is used in an ABCD2 score?
A - age > 60
B - BP > 140/90
C - clinical features of TIA: speech disturbance without weakness, or unilateral weakness
D - duration of symptoms: 10-59 mins, or >60 mins
D - diabetes
What do the ABCD2 scores mean?
1-3 = Low risk
- 2-day stroke risk = 1%
- 90-day stroke risk = 3%
4-5 = Moderate risk
- 2-day stroke risk = 4%
- 90-day stroke risk = 10%
6-7 = High risk
- 2-day stroke risk = 8%
- 90-day stroke risk = 18%
How does an ABCD2 score affect management?
High risk:
- dual antiplatelet therapy (aspirin 300mg + DOAC) should be started as soon as haemorrhage is ruled out
- admit patient for evaluation by neurologist/further imaging
Low risk:
- give aspirin 300mg
- refer to specialist and evaluate as an outpatient
What is a CHA2DS2-VASc score used for?
Estimating the risk of stroke of other thromboembolic event for patients with atrial fibrillation
What information is used in a CHA2DS2-VASc score?
C - congestive heart failure
H - hypertension
A2 - age >75
D - diabetes
S2 - stroke/TIA in past
V - vascular disease (past MI, PAD)
A - age > 65
S - female sex
What does a CHA2DS2-VASc score mean and how are they managed?
- 0 in males, 1 in females = low risk (no treatment needed)
- 1 in males, 2 in females = moderate risk (consider oral anticoagulation - apixaban)
- > 2 in males, >3 in females = high risk (offer oral anticoagulation - apixaban)
What is the Well’s score used for?
Estimating the risk of DVT (used in outpatient or emergency department settings)
What information is used in a Well’s score
- Active cancer
- Bedridden recently >3 days, or major surgery within 12 weeks
- Calf sweeling >3cm compared to the other
- Entire leg swollen
- Collateral (non-varicose) superficial veins present)
- Localised tenderness
- Pitting oedema of symptomatic leg
- Paralysis, paresis, or immobilization of leg
- Previously documented DVT
- Alternative diagnosis to DVT more or as likely (-2 points)
What does a Well’s score mean?
0 = low risk (“unlikely DVT”)
- probability = 5%
1-2 = moderate risk
- probability = 20%
3 or more = high risk (“likely DVT”)
- probability = 20-50%
How is each Well’s score category managed?
Low risk
- high or moderate sensitivity d-dimer
- if positive, procced to US
- positive US = anticoagulation
Moderate risk
- high sensitivity d-dimer
- if positive, proceed to US
- positive US = anticoagulation
High risk
- all patient receive US
- any positive US = anticoagulation
- d-dimer used to asses risk
