atrial fibrillation

And specifically for stroke prevention in atrial fibrillation, DOACs also generally cause less intracranial bleeding as compared to warfarin.

For atrial fibrillation, the decision on whether or not to anticoagulate is based on stroke risk.

As we discussed in episode 36 on arrhythmias, patients with AFib can develop clots in the left atrial appendage that can then travel to the brain.

The CHADS-VASc score is a commonly used risk assessment tool that considers risk factors for stroke, including heart failure, hypertension, advanced age, diabetes, prior stroke or TIA, vascular disease, and sex.

A CHADS-VASc score of at least two in men or three in women generally supports the decision to start anticoagulation.

The stroke prevention dose of apixaban is five milligrams taken twice daily, while rivaroxaban is usually 20 milligrams taken once daily.

And for patients with non-valvular AFib taking apixaban, something important to know is the two out of three rule, which is that if a patient meets any two out of the following three, age over 80, creatinine over 1.5, or weight under 60 kilograms, then the original apixaban dose should be cut in half, down to 2.5 milligrams twice daily.

For rivaroxaban, the usual 20 mg daily dose should be reduced to 15 mg for those with a creatinine clearance of 15-30, and rivaroxaban should be avoided altogether if they have a creatinine clearance less than 15.

Whoa.

That made my AFib go cray-cray.

Sausage, potato.

Holy shh.

I was like, okay, well, that's weird.

I woke up that morning and I went, I'm an atrial fibrillation.

I am an AFib right now.

I had no major amounts of stress.

I have had no major triggers.

But I went back into my watch's history.

And this is what's been really weird.

One year ago, this very week, I went into AFib.

Exactly.

Cause like when I started getting AFib, I was like freaking out because I was going, Oh my God, what's going on? But it's like, that led me down the road of like, you know, um, you know, research and all that.

And I realized that my, my iron was really low and it was, um, it was not, it was not anemic, but it was, um, it was getting, you know, into the, you know, the low.

And I, I found like knock on wood ever since I've been taking a healthy amount of, um, iron every day for the last like my afibs have been like the the the attacks that i where i was getting where there would be six hours with my heart one side of my heart going like 170 or something it was insane it's like i haven't had one of those for almost three months and it's like um i've had little ones that i can kind of sense And I can just take like a beta blocker or something and calm down.

I don't want to, you know, but this is the real thing.

You know, here I am going through the stress of being attacked at the polls, two days later going into AFib with RVR, three days later AFib with RVR, going to a hospital, having them ask for my credit card before a cardiologist even saw me, having a copay of $400 a day, which meant I was going to have to go into debt.

And then I get out and I want to follow up with my doctors and the test that they're ordering, my copay is $520.

I don't have $520.

I don't want to, you know, but this is the real thing.

You know, here I am going through the stress of being attacked at the polls, two days later going into AFib with RVR, three days later AFib with RVR, going to a hospital, having them ask for my credit card before a cardiologist even saw me, having a copay of $400 a day, which meant I was going to have to go into debt.

And then I get out and I want to follow up with my doctors and the test that they're ordering, my copay is $520.

I don't have $520.

feel bad or does he say anything?

Oh, well, then my dad's like got some like AFib thing with his heart and he blames it on the vaccine.

So he's very anti-vaccine now.

I am very much like, I mean...

And that's where the American College of Lifestyle Medicine and the board certification.

And Adam, I'm sure as you've recognized being an emergency medicine doctor, people often have asked me, how does lifestyle medicine fit in the emergency department? And I'm like, well, actually, it works really well, not with every single patient, but it's also being able to gauge who is the person that's ready to engage even in a brief conversation around the importance of lifestyle intervention if they're coming to see us for rapid AFib in the emergency department or some worst case scenario of their chronic condition that has brought them to the emergency department we actually can bring the lifestyle medicine focus even in the emergency department.

And so it's relevant across all healthcare.

Well, I wanna go back to the healthspan, lifespan issue, because I'm in women's health and that's a real conversation there about how women live longer than men, but they live a greater number of years in a poor state of health.