Home Diagnosis and Prognosis of Atrial Fibrillation
This program is untested in a clinical setting. The concept behind it is to attempt to make patients (people) more proactive in the diagnosis and treatment of the serious heart rhythm disturbance atrial fibrillation (AF). There are 2 million people in the US with AF. By 2050, there will be 3 million. From 2% to greater than 10% of these people will suffer a stroke from blood clots dislodging from the heart. Many people experience palpitations, passing out and dizziness which may be symptoms of AF. Treatment with blood thinners such as warfarin and aspirin can reduce the rate of stroke by 62% and 22% respectively. Unfortunately, physicians are not prescribing blood thinners frequently enough, failing to follow guidelines for a variety of reasons. It has been estimated that over 13,000 excess strokes occur per year in Britain due to this negligence. In the UK, researchers have introduced a computer program to inform the doctors of individual patient risk and to involve cardiologists in the recommendations. This computer program is my attempt to offer similar functionality to patients.
There are both Novice (patient) and Expert (physician) modes which can be selected under Options. The Expert mode allows the calculation of risk for stroke, bleeding and falling in specific situations. In addition, the Expert mode calculates initial and adjustment warfarin dosages based upon INR values.
References are provided throughout the program. The hyperlinks require an Internet connection.
After accepting the disclaimer, the program will execute. The disclaimer will not re-occur once it is accepted.
Declining will not allow program execution.
Courtesy Dr. John Havard "The Auricle"
Reproduced with permission from Copyright Holder, John Havard, Saxmundham, UK.
Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASPAF)
This program is a digitization of the act of Checking Your Pulse.
The opening screen can be disabled under Options.
The opening screen allows one to input the pulse by Left Clicking on the heart. You need to left click the heart with each heart beat. It will record a full 3 minutes of input but can be stopped sooner by Right Clicking the heart. In order to start over, one must select a New study from the File Menu. The best way to record one's pulse is using a stethoscope over the front of the left chest. Alternatively, one can track the radial pulse at the wrist. We do not advise manipulating the carotid pulse. Obviously, this methodology is far less accurate than a directly recorded electrocardiogram but for our purposes, it suffices.
We are considering the introduction of an inexpensive direct pulse monitor that will interface with the program.
This graphic shows the program in action and demonstrates the various options and reports.
Note below for further discussion.
The File Menu allows one to save and load multiple studies and start anew.
One can email the raw data to a doctor (below).
One can generate a PDF report of all completed forms and email this as well (below).
One may open the program directory and attach jpgs and pdfs to an email client manually too.
Clicking a .dat file loads the data and freezes input.
The files are sorted by date (ddmmyyhhmmss).
To input new data, one must create a New study from the File Menu.
Once data is loaded, the Reports may be accessed.
Upon completion of data input or after loading a saved study, the Report Menu is enabled with the above choices.
The Rhythm Report is very similar in appearance to an ECG. Most physicians can diagnose AF by reviewing this type of tracing. At the very least, a regular rhythm can be differentiated from an irregular one. One can print or save this report and email it to a physician for review. If suspicion is high enough, a physician might check an ECG.
Calipers are provided to track interval regularity and can be dragged around from the two corners.
The interval measured and the rate are tracked in the title.
The data may be plotted either sequentially or sorted. Green identifies the normal heart rate
while Blue is bradycardia (slow) and Red is tachycardia (fast).
The minimum rate, the median rate and the maximum rate is listed on the Y-axis.
The cross-hairs allow measurement of individual rates.
The sorted display is helpful for quantifying rate totals.
Statistical analysis is helpful for identifying the Standard Deviation (SD) and Variance around the mean.
The larger the SD, the more irregular the rhythm is and the more likely it is atrial fibrillation.
My classification is arbitrary in these regards.
The Chad2 score is derived from the following article:
Gage BF,Waterman AD, et al. Validation of clinical classification schemes for predicting stroke.
Results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285: 2864-2870.
It is a simple calculation and is applicable only to patients with non-valvular AF..
In general, a score of 0 is low risk. In this instance most would agree that aspirin therapy is appropriate.
A score of 1 or greater usually results in the prescription of warfarin.
Newer medications are actively being evaluated as are expanded criteria for risk.
Additional Risk Scores are added to CHAD2.
They may be accessed only in Expert Mode.
Medication Initiation and Adjustment of Warfarin dosage and Bridging.
Bridging recommendations are made for operative situations when oral
blood thinners must be stopped. These are based upon risk of stroke,
risk of bleeding and patient preference as firm guidelines haven't been
established to date.
The risk of falling is NOT an Evidence Based reason to without warfarin despite the fact that it is
frequently invoked by physicians. One study found "The calculated risk of subdural hematoma
from falling was such that a patient with a 5% annual stroke risk from atrial fibrillation would
need to fall 295 times in a year for the fall risk to outweigh the stroke reduction benefit of warfarin."
"Guidelines from the American Heart Association and the American College of Chest Physicians
do not include fall risk in the decision to use anticoagulation. Guidelines from the Institute for
Clinical Systems Improvement note that patients with 3 falls in the previous year or
with recurrent injurious falls were excluded from trials evaluating efficacy and safety of
anticoagulation in patients withnonvalvular atrial fibrillation."
Are major bleeding events from falls more likely in patients on warfarin?
VOL 55, NO 2 / FEBRUARY 2006 THE JOURNAL OF FAMILY PRACTICE
Included in the compiled version only
I've added the ability to email your data directly to your physician.
This is not included in the open source version
as it uses a commercial product, Chilkat.
(I may add Winsock support later to keep it open.)
Your doctor will need a copy of this program to view the data which is sent unencrypted.
You will need your SMTP Server Name, login and password information as well.
This is entered from the options menus.
This information is stored in the program directory unencrypted.
A list of SMTP server addresses for a large variety of ISPs is available from the
Help>SMTP Server List.
This is an example pdf report file which can be automatically emailed:
If you would like notification when this
page changes, use this Monitor