Faculty Articles

An Evaluation of Practitioners' Preference of Stroke Risk Tools in Nonvalvular Atrial Fibrillation: CHA2DS2VASC versus CHADS2

Publication Title

Journal of the American College of Cardiology

Publisher

JACC: Journal of the American College of Cardiology

ISSN

0735-1097

Publication Date

3-2018

Keywords

heart rhythm, nonvalvular atrial fibrillation (NVAF), pharmacists, stroke

Abstract

Background

Several stroke risk assessment tools exist. However, current nonvalvular atrial fibrillation (NVAF) guidelines differ in utilization of these tools. For instance, the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines recommend use of the CHA2DS2VASc score, whereas the American College of Chest Physicians (ACCP) guidelines endorse the CHADS2 score for stroke risk assessment.

Methods

In this cross-sectional, correlational study, an anonymous online survey was administered to practitioners nationally who routinely see patients with NVAF. The primary objective of this study was to determine prescribers' and pharmacists' preferences in the use of either the CHA2DS2VASc or CHADS2 scores in determining stroke risk in patients with NVAF by using this novel national survey. Chi-square analyses were conducted to test for differences in preference of stroke screening tools and guidelines employed.

Results

A total of 342 practitioners opened the distributed electronic survey. The survey was completed in entirety by 257 respondents. Of these, 11.28% were prescribers and 88.72% were pharmacists. Both pharmacists and prescribers responded that the CHA2DS2VASc was the most utilized scoring tool for stroke risk (71.0%). Overall, the most followed guidelines were ACCP (n=243). A statistically significant difference was found between prescribers who preferred the AHA/ACC/HRS guidelines, while pharmacists preferred using the ACCP guidelines (ACCP guidelines, Z=-2.99, p = 0.002; AHA/ACC/HRS guidelines, Z=3.47, p < 0.001).

Conclusion

Both pharmacists and prescribers prefer using the CHA2DS2VASc scoring tool for stroke risk assessment. However, despite agreeing on the stroke risk tool most utilized, discrepancies exist between practitioners in regards to guideline preference. This demonstrates that education and alignment of conflicting current guidelines is needed as many practitioners follow the ACCP guidelines, which recommend the CHADS2 score, despite stating utilization of the CHA2DS2VASc score.

DOI

10.1016/S0735-1097(18)33170-X

Volume

71

Issue

11 Supplement

Disciplines

Medicine and Health Sciences | Pharmacy and Pharmaceutical Sciences

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Peer Reviewed

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