AF Symposium 2017
New 2017 European A-Fib Stroke Risk Guidelines Changes & No Gender Bias
by Steve S. Ryan, PhD, Jan 19, 2017
Background: The controversy began with the HRS/ACC/AHA committee report, 2014 Guidelines for Management of Patients with Atrial Fibrillation. The rating scale, CHA2DS2-VASc, is used by doctors to assess an A-Fib patient’s risk of stroke. Magically, simply because of her gender, a woman with A-Fib is automatically given one point on the stroke risk scale―no matter how healthy she is otherwise.
Dr. John Camm from St. George’s Medical Center, London, UK discussed the new 2017 ESC (European) AF Stroke Risk Guidelines (i.e. CHA2DS2-VASc) compared to AF guidelines used around the world.
Gender Bias Reversed: The big news is that in the 2017 ESC Stroke Risk Guidelines for Atrial Fibrillation “gender is no longer an important consideration.”
The previous CHA2DS2-VASc risk scale automatically gave every woman with A-Fib an additional 1 risk point for just being female. Under the new 2017 Guidelines, anticoagulation recommendations are the same for men with 1 point as for women with 2 points. (“Sc” stands for sex i.e. female gender). This is a major change in anticoagulation treatment for women.
Anticoagulant Therapy: Under the 2017 European Guidelines, the newer NOACs (Novel Oral Anticoagulants) are recommended over the anticoagulant warfarin (Comadin).
In addition, antiplatelet drugs like aspirin are not recommended. The guidelines explicitly state that bleeding risk should be considered.
Patient’s choice: Another important change for European A-Fib patients is that many decisions previously dictated by the guidelines now read “patient choice.” For example, it’s now a patient/doctor decision to either try different antiarrhythmic drugs or catheter ablation.
What Patients Need To Know
For a further discussion of the gender controversy, see my article, The Controversy Continues: Women, Anticoagulants, CHA2DS2-VASc and Risk of Bleeding
Keep in mind: all anticoagulants are high risk medications. They work by increasing your risk of bleeding.
Why not drop the “Sc”? Removing the bias against women in the 2017 European A-Fib Stroke Risk Guidelines is a welcome change. But, one wonders why they didn’t just drop the extra point for being female? And make the acronym “CHA2DS2-VA” without the “Sc”? it’s still confusing for women and even for their doctors.
For example, why should a man with hypertension be given 1 point on the stroke risk score, while a woman with hypertension is given 2 points? Even if under the new European Guidelines, a man with 1 point is treated the same as a woman with 2 points, does this make any sense? It sounds like the writers of the Guidelines recognize their error and bias against woman (probably influenced by drug companies), but won’t actually change the guidelines so as not to lose face and acknowledge their error.
This change is historically significant. Dr. Camm was one of the principal authors of the original CHA2DS2-VASc guidelines which automatically gave a woman with A-Fib one point on the stroke risk scale.