CHA2DS2-VASc
Decision Logic Module
This DLM is a direct translation of the Cambio CHA2DS2-VASc.v1 GDL2 guideline.
dlm CHA2DS2_VASc.v0.5.0
definitions -- Descriptive
language = {
original_language: [ISO_639-1::en]
}
;
description = {
lifecycle_state: "unmanaged",
original_author: {
name: "Thomas Beale",
email: "models@cambiocds.com",
organisation: "Cambio Healthcare Systems <https://www.cambiogroup.com>",
date: "2016-12-16"
},
details: {
"en" : {
language: [ISO_639-1::en],
purpose: "To record an individual's CHA2DS2-VASc score parameters and total score.",
use: "Use for stroke risk stratification in patients with atrial fibrillation.
CHA2DS2-VASc is an acronym, with each factor contributing points to the
total score:
- Congestive heart failure 1p
- Hypertension 1p
- Age ≥75 years 2p
- Diabetes1p
- Stroke 2p
- Vascular disease 1p
- Age 65–74 years 1p
- Sex category 1p for female"
}
},
copyright: "© 2021 openEHR Foundation",
licence: "Creative Commons CC-BY <https://creativecommons.org/licenses/by/3.0/>",
ip_acknowledgements: {
"ClinRisk" : "This content developed from original publication of
© 2017 ClinRisk Ltd., see https://qrisk.org",
"QRISK" : "QRISK® is a registered trademark of the University of Nottingham and EMIS"
},
references: [
"Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk
stratification for predicting stroke and thromboembolism in atrial
fibrillation using a novel risk factor-based approach: the euro heart survey
on atrial fibrillation. Chest. 2010 Feb;137(2):263-72.",
"Camm a J, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al.
Guidelines for the management of atrial fibrillation: the Task Force for
the Management of Atrial Fibrillation of the European Society of Cardiology
(ESC). Eur Heart J. 2010 Oct;31(19):2369–429.",
"Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk
for stroke despite anticoagulation: a comparison of contemporary stroke risk
stratification schemes in an anticoagulated atrial fibrillation cohort.
Stroke. 2010 Dec;41(12):2731-8.",
"Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes
for ischaemic stroke and bleeding in 182 678 patients with atrial
fibrillation: the Swedish Atrial Fibrillation cohort study.
Eur Heart J. 2012 Jun;33(12):1500-10."
]
}
;
use
BASIC: Basic_patient_data
input -- Historical state
has_congestive_heart_failure: Boolean
;
has_hypertension: Boolean
;
|
| Has recently had or currently has a stroke, TIA or thromboembolism
|
has_stroke_TIA_thromboembolism: Boolean
;
has_diabetes: Boolean
;
has_vascular_disease: Boolean
;
rules -- Main
|
| Convert sex to binary gender;
| treat indeterminate sex as female
|
gender: Terminology_code «sexes»,
Result := case BASIC.sex in
=====================
#male: #male,
---------------------
*: #female
=====================
;
age_score: Integer
Result := case BASIC.age_in_years in
================
|<65|: 0,
----------------
|65..74|: 1,
----------------
|≥75|: 2
================
;
CHA2DS2_VASc_score: Integer
Result.add (
---------------------------------------------
BASIC.gender = #male ? 1 : 0,
age_score,
has_congestive_heart_failure ? 1 : 0,
has_hypertension ? 1 : 0,
has_stroke_TIA_thromboembolism ? 2 : 0,
has_vascular_disease ? 1 : 0,
has_diabetes ? 1 : 0
---------------------------------------------
)
;
rules -- Output
|
| The maximum score is 9 and the result is interpreted as;
| 0 - low risk
| 1 - intermediate risk
| 2 or more - high risk
|
risk_assessment: Terminology_code «risks»
Result := case CHA2DS2_VASc_score in
=============================
0: #low_risk,
1: #intermediate_risk,
|≥2|: #high_risk
=============================
;
|
| Further interpretation in accordance with #4
|
annual_stroke_risk: Real
Result := case CHA2DS2_VASc_score in
==============
0: 0.0%,
1: 0.6%,
2: 2.2%,
3: 3.2%,
4: 4.8%,
5: 7.2%,
6: 9.7%,
7: 11.2%,
8: 10.8%,
9: 12.2%
==============
;
|
| Further interpretation in accordance with #4
|
annual_stroke_TIA_thromboembolism_risk: Real
Result := case CHA2DS2_VASc_score in
==============
0: 0.0%,
1: 0.9%,
2: 2.9%,
3: 4.6%,
4: 6.7%,
5: 10.0%,
6: 13.6%,
7: 15.7%,
8: 15.2%,
9: 17.4%
==============
;
definitions -- Terminology
terminology = {
term_definitions: {
"en" : {
"date_of_birth" : {
text: "Date of birth",
provenance: "GDL2" : ["gt0009"]
},
"age_in_years" : {
text: "Age (years)",
provenance: "GDL2" : ["gt0010"]
},
"age_category" : {
text: "Age category",
provenance: "GDL2" : ["gt0017"]
},
"gender" : {
text: "Gender",
provenance: "GDL2" : ["gt0009", "gt0016"]
},
"has_congestive_heart_failure" : {
text: "xxx",
provenance: "GDL2" : ["gt0011", "gt0018"]
},
"has_hypertension" : {
text: "xxx",
provenance: "GDL2" : ["gt0012", "gt0019"]
},
"has_diabetes" : {
text: "Diabetes",
provenance: "GDL2" : ["gt0015", "gt0022"]
},
"has_stroke_TIA_thromboembolism" : {
text: "Stroke/TIA/Thromboembolism",
provenance: "GDL2" : ["gt0013", "gt0020"]
},
"has_vascular_disease" : {
text: "Vascular disease",
provenance: "GDL2" : ["gt0014", "gt0021"]
},
"male" : {
text: "Male gender",
provenance: "GDL2" : ["gt0035"]
},
"female" : {
text: "Female gender",
provenance: "GDL2" : ["gt0025"]
},
"CHA2DS2_VASc_score" : {
text: "CHA2DS2VASc score",
provenance: "GDL2" : ["gt0011"]
},
"risk_assessment" : {
text: "Risk assessment",
provenance: "GDL2" : ["gt0005"]
},
"annual_stroke_risk" : {
text: "Annual stroke risk",
provenance: "GDL2" : ["gt0006"]
},
"annual_stroke_TIA_thromboembolism_risk" : {
text: "Annual risk of stroke/TIA/thromboembolism",
provenance: "GDL2" : ["gt0011"]
},
"low_risk" : {
text: "Low risk"
},
"intermediate_risk" : {
text: "Intermediate risk"
},
"high_risk" : {
text: "High risk"
}
}
},
value_sets: {
"genders" : {
id: "genders",
members: ["male", "female"]
},
"risks" : {
id: "risks",
members: ["low_risk", "intermediate_risk", "high_risk"]
}
}
}
;Bindings
The following defines the logical bindings of DLM variables to back-end data.
--
-- Demographic items: AQL query
--
SELECT
OBS/data#at0001/events#at0002/data#at0003/items#at0004 AS date_of_birth,
OBS/data#at0001/events#at0002/data#at0003/items#at0008 AS sex
C/context/start_time AS time
FROM
EHR e[ehr_id/value=$ehrUid]
CONTAINS COMPOSITION C
CONTAINS OBSERVATION OBS[openEHR-EHR-OBSERVATION.basic_demographic.v1]
ORDER BY
time DESC
--
-- CHA2DS2-VASc input items
--
SELECT
OBS/data#at0002/events#at0003/data#at0001/items#at0026 AS has_congestive_heart_failure,
OBS/data#at0002/events#at0003/data#at0001/items#at0029 AS has_hypertension,
OBS/data#at0002/events#at0003/data#at0001/items#at0039 AS has_stroke_TIA_thromboembolism,
OBS/data#at0002/events#at0003/data#at0001/items#at0046 AS has_vascular_disease,
OBS/data#at0002/events#at0003/data#at0001/items#at0032 AS has_diabetes,
C/context/start_time AS time
FROM
EHR e[ehr_id/value=$ehrUid]
CONTAINS COMPOSITION C
CONTAINS OBSERVATION OBS[openEHR-EHR-OBSERVATION.chadsvasc_score.v1]
ORDER BY
time DESC