This appears to be flavour of the month and has reared its head in a
local prescribing incentive point.
My first question is has anyone found a way to make EMIS auto
calculate the score similar to the Framingham score read code?
Secondly, am I alone in just not quite believing the recommendation
from Chads2 that if you have AF, and are over 75 with hypertension you
should be on warfarin (2 points).
I had previously worked on ...
untreated AF = 5% chance stroke/year
AF on aspirin 3% stroke/year
AF on warfarin 2% stroke/year but add in a 1% chance of major haemorrhage
which takes you into the minefield of how you explain benefits/risks.
e.g do you say
a) treating AF patients with warfarin can prevent 64% of strokes
or
b) lots of additional trips to clinic, added worry about food and
drink, possibility for dosing error and interactions, no grapefruit or
cranberry (surprisingly popular around here ??) and increased risk of
serious bleed will reduce your chance of stroke by 1% a year
I accept wafarin probably the gold standard for a switched on
confident type thats not on too many other meds, but just don't buy
the current froth about it being so much better for the lowish risk
groups.
Reminds me of everyone should be on HRT, everyone should be on a
statin, diabetics should eat lots of starch not sugar, colloid is best
for major bleeds, leeches on the cervix are gold standard for
menorrhagia .....
|