#+TITLE: EP Mobile Development Notes
* Features
** DONE Dofetilide Calculator
** DONE QTc Calculator
** DONE CL/HR Converter
** DONE WPW Accessory Pathway localizer
*** Milstein et al.  PACE 10:555, 1987.
*** Arruda 1998
** DONE VT vs SVT Brugada algorithm
*** Proposed implementation
    | Follow steps in order: |                                                  |     |
    | Step 1                 | Absence of an RS Complex in all precordial leads | Y/N |
    |                        | Y = VT                                           |     |
    | Step 2                 | R to S interval > 100 ms in one precordial lead  | Y/N |
    |                        | Y = VT                                           |     |
    | Step 3                 | AV Dissociation                                  | Y/N |
    |                        | Y = VT                                           |     |
    | Step 4                 | Morphology criteria in V1-2 and V6               | Y/N |
    |                        | Y = VT                                           |     |
*** Morphology criteria
    - RBBB QRS
      - Lead V1
	- Monophasic R or QR or RS favors VT
	- Triphasic RSR' favors SVT
      - Lead V6
	- R to S ratio < 1 (R small than S) favors VT
	- RS or QR favors VT
	- Monophasic R favors VT
	- Triphasic favors SVT
	- R to S ration > 1 favors SVT
    - LBBB QRS
      - Lead V1 or V2
	- Any of the following R > 30 ms, >60 ms to nadir S, notched S favors VT
      - Lead V6
	- Presence of any Q wave, QR or QS favors VT
	- Absence of Q wave in V6 favors SVT
*** Reference
    http://askdrwiki.com/mediawiki/index.php?title=Brugada_Criteria#Four_Brugada_Criteria_for_Diagnosis_of_Ventricular_Tachycardia
** DONE CHADS score
** DONE CHADS-VASc score
** DONE HAS-BLED
   | Risk                           | Score |
   | HTN (sys >= 160)               |     1 |
   | Abnormal Kidney Cr>2.6 mg/dL   |     1 |
   | Abnormal Liver                 |     1 |
   | Previous Stroke                |     1 |
   | Hx Bleeding or Anemia          |     1 |
   | Labile INR (< 60% therapeutic) |     1 |
   | Elderly (65 or older)          |     1 |
   | Drugs - antiplatelet             |     1 |
   | Drugs - EtOH (>= 8 drinks/wk)  |     1 |
   - Score of 3 or more indicates caution in using AC and increased 1 year
     risk of bleeding.
** DONE ARVD score
** DONE Pradaxa dose calculator
** DONE Warfarin dose calculator
** DONE Rivoraxaban dose calculator
** DONE SQTS diagnosis
** TODO Epicardial vs endocardial VT
** TODO Mitral annular VT
** DONE Brugada ECG types
** DONE LVH
** DONE Normal EP Values
** TODO EP Glossary
** DONE CMS ICD criteria
** DONE LQTS criteria
** TODO ACC WCT algorithm
** TODO Creatinine Clearance calculator
** TODO Para-Hisian pacing guide
** TODO Apical vs septal pacing guide
* Menu
** units
*** msec or sec
*** metric or US
** QTc formulae
*** DONE Bazett's (default)
*** DONE all others!
*** implementation*
*** DONE Java class QtcCalculator
*** Normal values
**** DONE Color code abnormal QTc
* Issues
** Themes
   We are using default Android theme.  android:background settings
   probably should not be used.  Should try to use Android predefined
   text settings and not specific colors.  Potentially could have an
   application theme which by default is the default Android theme,
   but with the ability to override it.
** Strings
   Still have a mixture of strings in strings.xml and in code.  All
   strings (except maybe some numbers) should be in strings.xml.
** Grouping
*** DONE add Warfarin dose calculator to Drug Dose Calculators group
*** ? other groups
    - Risk Scores
    - Diagnostic Scores
    - ECG patterns
* Main screen
** New screen
   Need alphabetized grouped by letter scrollview list
* Implementation
** Abstract base classes
*** DONE For creatinine clearance based calculators
*** DONE For scores
* Warfarin
  | Day  | Change1 | Change2 |
  | Sun  | 1 tab   | 1 tab   |
  | Mon  |         |         |
  | Tues |         |         |
  | Wed  |         |         |
  | Thur |         |         |
  | Fri  |         |         |
  | Sat  |         |         |
  |------+---------+---------|
** 
* Style
** General
*** lower_case_hyphenated
*** separate_numbers_1
** Titles vs Labels
   Activities have titles, everything else has labels
* Eclipse set up
** Android 4 SDK
** Window->Preferences->Android->Editors->Format on Save
** Window->Preferences->Android->Java->Editor->Perform selected actions on save
*** Format Source code -> Format all lines
** Project->Properties->Android->Project Build Target Android 4.0
** 
* References
** RV dysplasia
   http://arvc.ca/arvc/info/i.php?ix=1&pag=3
** WCT algorithms
   http://askdrwiki.com/mediawiki/index.php?title=Brugada_Criteria#Four_Brugada_Criteria_for_Diagnosis_of_Ventricular_Tachycardia
   http://en.ecgpedia.org/wiki/Approach_to_the_Wide_Complex_Tachycardia
** RWPT
   http://www.heartrhythmjournal.com/article/S1547-5271%2810%2900216-X/abstract
* WCT
** Wellens morphology criteria
*** ECGpedia
    - LBBB VT
      - Initial R > 40 ms in V1 or V2 => VT
      - RS > 100 ms in V1 or V2 => VT (redundant, already in Step 1?, Brugada)
      - Slurred or notched S in V1 or V2 => VT
      - Q to nadir QS > 60 ms in V1 or V2 => VT
      - Q or QS in V6 => VT
    - RBBB VT
      - Monophasic R or qR in V1 => VT
      - R taller than R' (rabbit ears) in V1 => VT
      - rS in V6 => VT (i.e. RS ratio < 1)
*** Brugada et al.
**** Notes
     - Text only refers to V1 and V6, figure (Fig 1) refers to V1-2 and
       V6
     - Table 1 on morphology criteria uses V1 for RBBB but V1 or V2 for LBBB
     - In text, step 4 = "if the tachycardia fulfilled the morphology criteria
       for VT in leads V1 and V6, the diagnosis of VT was made."
**** Criteria from Table 1
     - LBBB VT
       - Lead V1 or V2
	 - R > 30 msec or > 60 msec to nadir S or notched S 
       - Lead V6
	 - QR or QS
	 - Monophasic R indeterminate
	 - Triphasic SVT
     - RBBB VT
       - Lead V1
	 - Monophasic R
	 - QR or RS
	 - Triphasic => SVT
       - Lead V6
	 - R to S ratio < 1
	 - QS or QR
	 - Monophasic R
	 - Triphasic => SVT
	 - R to S > 1 => ?VT or SVT
*** Final criteria
    - LBBB VT
      - Lead V1 or V2
	- R > 30 msec
	- RS > 60 msec
	- Notched S
      - Lead V6
	- QR
	- QS
    - RBBB VT
      - Lead V1
	- Monophasic R
	- QR
	- RS
      - Lead V6
	- R to S < 1
	- QR
	- QS
	- Monophasic R
*** Analysis
**** Wellens
***** At least 1 point in V1 and V6 => VT
***** Zero points => SVT
***** V1 and V6 discordant => indeterminate
***** Include rabbit ears? - not listed in Brugada
**** Brugada
***** At least 1 point in V1 and V6 => VT
***** Otherwise SVT
*** Implementation
    - Use figures and text for morphology criteria
    - Use checklist for Brugada morphology criteria
* Short QT Syndrome
** fine print of algorithm
   - Jpoint-Tpeak interval measured in precordial lead with greatest
     amplitude T wave.
   - Clinical History: events must occur in the absence of an
     identifiable etiology, including structural heart disease.
   - Points can only be received for 1 of cardiac arrest, documented
     polymorphic VT, or unexplained syncope.
   - Family history points can only be received once int his section.
   - A minimum of 1 point must be obtained in the ECG section in order
     to obtain additional points.  
* Rivaroxaban
  | CrCl           | Dose                          |
  | > 50 ml/min    | 20 mg daily with evening meal |
  | 15 - 50 ml/min | 15 mg daily with evening meal |
  | < 15 mL/min    | avoid                         |
* ICD Criteria
  1. Documented cardiac arrest due to VF, not due to transient or
     reversible cause.
  2. Documented sustained ventricular tachyarrhythmia, either
     spontaneous or induced by EP study, not associated with an acute
     MI, and not due to a transient or reversible cause.
  3. Documented familial or inherited conditions with a high risk of
     life-threatening VT, such as long QT syndrome or hypertrophic
     cardiomyopathy.
  4. Documented prior MI, EF <= 35%, and inducible sus VT or VF at
     EPS.  (MI more than 40 days pre-ICD, and EPS performed > 4 weeks
     post MI.)
  5. Documented prior MI and EF <= 30%
  6. ICM, documented prior MI, Class II or III HF, EF <= 35%.
  7. NICM, > 9 months, Class II or III HF, EF <= 35%.
  8. Pts who meed CMS coverage criteria for CRT device and have Class
     IV HF.
  9. NICM > 3 months, Class II or III, and EF <= 35%.
** Exclusions
*** Cardiogenic shock or symptomatic hypotension
*** CABG or PCI within past 3 months
*** Acute MI within 40 days
*** Symptoms or findings that would make patient a candidate for revascularization
*** Irreversible brain damage from preexisting cerebral disease
*** Non-cardiac disease with likelihood of survival < 1 year
** Patients must be enrolled in ICD registry
** Note exclusions and registry apply to the primary prevention indications
** Parameters
   - Cardiac arrest y/n
   - sustained VT/VF spontaneous
   - sustained VT/VF induced
   - familial high risk condition
   - EF <= 35%
   - EF <= 30%
   - Documented MI
   - ICM
   - NICM
   - NYHA Class
   - Duration of CM
   - CRT indication
** Simplified Parameters
   - [ ] Cardiac arrest due to VF not due to reversible cause
   - [ ] Spontaneous or inducible VT/VF
   - [ ] Familial high risk condition (e.g. LQTS, HCM)
   - [ ] Documented MI
   - [ ] Ischemic CM
   - [ ] Nonischemic CM
   - [ ] Duration of CM
   - [ ] EF (radio group)
   - [ ] NYHA class (radio group)
   - [ ] CRT Indication?
*** Exclusions
    - [ ] Cardiogenic shock or symptomatic hypotension
    - CABG or PCI withing past 3 months
    - Acute MI within 40 days
    - Symptoms or findings that would make patient a candidate for revascularization
    - Irreversible brain damage from preexisting cerebral disease
    - Non-cardiac disease with likelihood of survival < 1 year
** Logic
   - Apply exclusions only where they should be (Primary prevention)
   - 3 month limit only for NICM
   - If indicated by too soon, say so
   - CRT indication only enters into Class IV CHF
     - Class IV excludes other indications
** Additional info
   - ACC/AHA/HRS indication
   - cite which CMS indication it falls under
   - button to list CMS indications
   - button to list AHA indications
   - change module to ICD indications?
   - maybe separate modules for CMS, AHA?
   - show study that supports each indication
     - AVID
     - MADIT II
     - etc.
* Unicode symbols
  |-------------------------+----------|
  | Description             | Hex Code |
  |-------------------------+----------|
  | right pointing triangle | \u25b6   |
  | <                       | \u003c   |
  | >                       | \u003e   |
  | ≤                       | \u2264   |
  | ≥                       | \u2265   |
  | subscript 2             | \u2082   |
  | ±                       | \u00b1   |
  | Black star  ★           | \u2605   |
  | degree °                | \u00b0   |
  |-------------------------+----------|
  - insert unicode char in emacs: C-x 8 RET name of char or code number
  - Note, necessary to add formatted="false" to string tag if using
    more than 2 % symbols in a string (bug).
* WPW Arruda algorithm
** Locations
   - LPL
   - LL
   - LAL
   - LP
   - PSTA
   - L FREE WALL
   - SUBEPICARDIAL
   - PSMA
   - AS
   - MSTA
   - RA
   - RAL
   - RL
   - RP
   - RPL
* DONE add transparent backgrounds to png
* New Main Menu
** Calculators
*** TODO Creatinine Clearance Calculator
*** Cycle Length Calculator
*** Drug Dose Calculators
**** Dabigatran Calculator
**** Dofetilide Calculator
**** Rivaroxaban Calculator
**** Warfarin Calculator
*** QTc Calculator
** Diagnosis
*** ARVC/D
**** ARVC/D 1994 Diagnostic Criteria
**** ARVC/D 2010 Diagnostic Criteria
*** Brugada
*** Left Ventricular Hypertrophy
**** Romhilt-Estes LVH Score
**** LVH Voltage Criteria
*** Long QT Syndrome
**** Long QT Syndrome Diagnosis
**** Long QT Subtypes
**** Long QT ECG
*** Short QT Syndrome Diagnosis
*** TODO Ventricular Tachycardia
**** TODO Epicardial VT Criteria
**** TODO Outflow Tract VT
**** TODO Mitral Annular VT
*** Wide Complex Tachycardia
**** Brugada Algorithm
**** Morphology Criteria
**** R Wave Peak Time Criterion
*** WPW Pathway Location
**** Anatomy of AV Annulus
**** Arruda Algorithm
**** Modified Arruda Algorithm
**** Milstein Algorithm
** Reference
*** CMS Criteria
*** TODO EP Glossary
*** Normal EP Values
*** TODO ParaHisian Pacing
*** TODO RVA vs RVS Pacing
** Risk Scores
*** CHADS2 Score
*** CHADS-VASc Score
*** HAS-BLED Score
*** HEMORRHAGES Score
*** HCM Sudden Death Risk Score
* VT Patterns
** Epicardial vs Endocardial
*** Bazan et al.http://www.ncbi.nlm.nih.gov/pubmed/17018339 
    - epicardial vs endocardial RV
    - Q or QS pattern in sites of origin
    - No predictor for RVOT epi vs endo
    - LV epi vs endo patterns not predictive:
      - pseudo-delta wave >= 34 ms
      - intrinsicoid deflection time >= 85 ms
      - RS complex >= 121 ms.
	- RV epicardial vs endocardial VT
	- LV criteria for epicardial
	  - Pseudo-delta wave (>= 34 ms)
	  - intrinsicoid deflection time >= 85 ms
	  - RS complex >= 121 ms
	- Above criteria do not identify RV epicardial origin
*** Berruezo A et al.  http://circ.ahajournals.org/content/109/15/1842.full
    Circulation 2004;109:1842-1847
    - Pseudo delta: earliest V activation to earliest fast deflection
      in any precordial lead.
    - Intrinsicoid Deflection Time: earliest V activation to peak of R
      wave in V2.
    - Shortest RS complex: earliest V activation to nadir of
      first S wave in any precordial lead.
    - QRS duration: earliest V activation to offset of QRS in
      precordial leads.
    - Proposed criteria
      - pseudodelta >= 34 ms Sens 83%, Spec 95%
      - intrinsicoid deflection time >= 85 ms Sens 87% Spec 90%
      - RS complex duration >= 121 ms Sens 76% Spec 85% for epi VT
** RVOT vs LVOT
   - Joshi and Wilber
     - Free wall vs septal
       - QRS >= 140 msec
       - R wave notching in inferior leads
       - V3 R/S ratio <= 1
     - Anterior vs posterior
       - negative or isoelectric QRS in I
     - Caudal (> 2 cm from PV)
       - isoelectric or + QRS in avL
     - LV
       - RS ratio >= 1 in V1 or V2
   - Tada JACC Mitral annular VT
     - Transition < V2 and R or Rs in V2 to V6 (R/S > 3 in V2-V4) = MAVT
     - + QRS in inferior leads
       - yes: Notching in R wave inferior leads
	 - yes: anterolateral
	 - no: anteromedial
       - no: Notching of Q wave in inferior leads and no q or s wave
         in V1 and transition < V1
	 - yes: posterior
	 - no: posteroseptal
   - Srivathsan Indian Pacing J
     - LBBB pattern (transition V3 or later)
       - yes: RVOT but see above
       - no: ie transition V1 or V2, S in I
	 - absent S in V5 or V6: supravalvular LVOT
	 - present: infravalvular
*** Proposed algorithm
    - Enter transition lead (first lead R > S)
      - V1 V2 V3 V4 or later
    - V3, V4 or later
      - RVOT, possible RVOT or LVOT if V3
	- QRS >= 140 ms or R wave notching inferior leads and V4 transition
	  - Is free wall, otherwise septal
	- negative or iso QRS in I
	  - Anterior, otherwise posterior
	- iso or - QRS in avL
	  - caudal vs cranial
      - V2 or V1 transition
	- V1 transition and R or Rs in V2 to V3 (R/S > 3 in V2-V4)
	  - MAVT: use above algorithm
	- 
** Fasicular VT/Idiopathic LVT
** Mitral annular VT
   http://www.sciencedirect.com/science/article/pii/S0735109704025094
   Tada H et al.  JACC 2005;45:877-886
* Drugs
** Amiodarone
*** Metabolism
    - CYP3A4, CYP2C8
    - Also inhibits CYP3A4
    - active metabolite N-desethylamiodarone (DEA)
*** Pregnancy
    - cross placenta
    - appears in breast milk
*** Renal Failure
    Not dialyzable
*** Drug levels not useful
*** Half-life
    20 - 47 days (DEA same or longer)
*** Side-effects
**** IV amio
     - hypotension
     - bradycardia
     - hepatic injury
     - proarrhythmia
       - with fluoroquinolones, macrolide antibiotics, azoles
     - acute onset pulmonary toxicity, ARDS
**** Oral amio
*** Drug interactions
**** CYP3A inhibitors increase amio concentration
     - protease inhibitors
     - Cimetidine
     - grapefruit juice
**** Amio inhibits certain CYP450 enzymes, increasing other drug concentrations
     - cyclosporine (CYP3A4)
     - simvastatin (CYP3A4)
     - digoxin levels increase 70% in one day
     - propranolol (CYP3A4 inhibitor)
     - verapamil (CYP3A4 substrate)
     - diltiazem (CYP3A4 inhibitor)
     - warfarin (CYP3A4 and CYP2C9 substrate)
       - increases PT 100% after 3-4 days
       - reduce warfarin dose 1/3 to 1/2
     - rifampin (CYP3A4 inducer) reduces amio levels
     - St. John's wort (CYP3A4 inducer) reduces amio levels
     - Misc
       - fentanyl, dextromethorphan, cholestyramine, disopyramide
       - fluroroquinolones (levofloxacin, ciprofloxacin, etc.),
         macrolide antibiotics (erythromycin, clarithromycin, but not
         azithromycin (does not inhibit CYP3A4), azoles
         (e.g. ketoconazole)
** Drug Interaction Module
*** Layout?
    - Contraindicated drug list
    - Drugs that increase drug levels
    - Drugs that decrease drug level
    - Increase levels of drugs
    - Decrease levels of drugs
*** Example: Amiodarone
    - Contraindicated
    - Drugs that increase amiodarone levels
      - CYP3A4 inhibitors
	- protease inhibitors (e.g. indinavir)
	- loratadine (Claritin)
	- cimetidine
	- trazadone
	- grapefruit juice
    - Drugs that reduce amiodarone levels
      - rifampin
      - St. John's wart
    - Misc interactions
      - fentanyl
      - lidocaine
      - dextroethrophan
      - cholestyramine
      - volatile anesthetic agents
    - Amiodarone increases drug effects
      - inhalation anesthetics
      - flecainide
      - phenytoin
      - (quinidine, procainamide, all AADS)
      - Coumadin - reduce dose 1/3 to 1/2 with amio
      - BBs (pharmacodynamic effect)
      - digoxin - reduce dose by at least 50%
      - diuretics (hypokalemia)
      - fluoroquinolones, macrolide antibiotics, azoles
      - cyclosporine
      - simvastatin
      - atorvastatin
      - digoxin
      - propranolol
      - verapamil
      - diltiazem
      - warfarin
      - clopidogrel
*** Multaq
    - CYP3A inhibitor
      - increases statins
      - increases CCB
      - increases propranolol
      - increases digoxin
      - no warfarin 
    - Also inhibits P-glycoprotein (P-gp) transport
     - increases digoxin level, BB and CCB levels
    - Contraindicated
      - strong CYP3A inhibitors
	- ketoconazole
	- cyclosporine
	- clarithromycin
      - QT prolonging drugs
    - increase Multaq levels
      - CYP3A inhibitors
	- Grapefruit juice
	- verapamil, diltiazem
    - increases drug levels
      - digoxin
      - CCBs
      - BBs
      - statins
*** Pradaxa
    - metabolized by P-gp
    - not metabolized by CYP450 enzymes
    - reduce dose to 75 mg bid when dronedarone or ketoconazole
      administered and CrCl 30-50 mL/min
    - increase Pradaxa levels
      - dronedarone
      - ketoconazole
      - verapamil (probably not clinically important)
      - no important effect from amiodarone
*** Tikosyn
    - iKr blocker
    - Renal excretion, small metabolism by CYP3A4
    - Contraindications
      - cimetidine
      - verapamil
      - ketoconazole
      - trimethoprim with or without sulfamethoxazole
      - HCTZ
*** Warfarin
    - multiple CYP450 enzymes involved in metabolism, esp CYP2C9
    - some common/cardiac drugs that interact
      - amiodarone, cipro, mexiletine, BCPs, propafenone, propranolol,
        verapamil, amlodipine, atorvastatin, cimetidine, diltiazem
*** sotalol
    - not metabolized, only renally excreted unchanged
    - AFB package insert dosing
      - do not start if QTc > 450 msec
      - 80 mg BID if CrCl > 60 ml/min, 80 mg once daily if 40-60.
        Contraindicated if CrCl < 40.  
      - can increase to 120 mg or 160 mg if QTc < 500 ms
      - 3 days recommended for hospitalization
* AT Location
** Kistler et al. Summary
   - in V1, - or + /- P 100% specific RA
   - in V1, -/+ or + P 100% sensitive LA
   - Algorithm sensitivity = 93%
   - P wave must have discrete iso segment before (i.e. not fused with
     T wave, etc.)
   - isoelectric means no P-wave deviation from the baseline of >=
     0.05 mV
   - Algorithm is for focal AT only
* Entrainment
** Sources
   - http://askdrwiki.com/mediawiki/index.php?title=Entrainment
   - http://content.onlinejacc.org/article.aspx?articleid=1121699
** Criteria
   - Concealed fusion y/n
   - S-QRS interval
     - Exit site S-QRS < 30% TCL
     - Central site S-QRS > 31-50% TCL
     - Proximal Site S-QRS 51-70%
     - Inner Loop S-QRS > 70%
   - TCL
   - PPI
   - PPI - TCL <= 30 msec in circuit
   - EGM-QRS interval
     - in circuit (with concealed fusion) S-QRS = EGM-QRS +/- 20 msec
** Long QT drugs
*** website: http://www.azcert.org/medical-pros/drug-lists/printable-drug-list.cfm
* DONE Verecki algorithm
** Algorithm (uses only lead avR)
   1. evaluate presence of initial R wave in avR
   2. initial r or q with width >= 40 msec
   3. notching on descending limb of a negative onset, predominantly
      negative QRS complex.
   4. Vi/Vt <= 1
      1. Vi = initial ventricular activation velocity
      2. Vt = terminal ventricular activation velocity
      3. Measured by excursion in mV recorded on the ECG during the
         initial Vi and terminal Vt 40 msec of the QRS
** Use of algorithm
   Similar to Brugada.  Yes at each step means VT.
** References
   http://academics.ochsner.org/uploadedFiles/Education/Library/Healthcare_Professionals/Differentiating%20Wide%20Complex%20Tachycardia_Saad.pdf
   http://www.heartrhythmjournal.com/article/S1547-5271(07)00943-5/abstract
* DONE New ICD risk algorithm
  - Female sex 2 points
  - Reason for admission
    - admitted for procedure 0
    - heart failure 4
    - other 5
  - NYHA functional class
    - I/II 0
    - III 3
    - IV 7
  - No prior CABG 2
  - Current dialysis 3
  - Chronic lung disease 2
  - Abnormal conduction
    - No 0
    - Yes LBBB 2
    - Yes other 2
    - (could be checkbox - abnl conduction yes/no)
  - Procedure type
    - Initial implant 13
    - gen replacement ERI 0
    - gen replacement infection 17
    - gen replacement device relocation 18
    - gen replacement upgrade 12
    - gen replacement malfunction 13
    - gen replacement other 14
  - ICD type
    - Single chamber 0
    - Dual chamber 4
    - CRT-D 6
  - Sodium
    - < 135 3
    - 135-145 0
    - > 145 2
  - Hgb
    - < 12 3
    - 12-14 2
    - > 14 0
  - BUN
    - < 20 0
    - 20-40 2
    - > 40 4
** Results
   - score <= 10 risk 0.3%
   - score >= 30 risk 4.2%
   - score 10-30 in between
** Outcome
   in-hospital complications or mortality
* New scores [2015-11-29 Sun]
** DONE ATRIA Bleeding risk score
CLOSED: [2015-11-29 Sun 15:23]
:LOGBOOK:
- State "DONE"       from              [2015-11-29 Sun 15:23]
:END:
*** Reference
[[http://content.onlinejacc.org/article.aspx?articleid=1146658#tbl3][JACC article]]
[[http://www.mdcalc.com/atria-bleeding-risk-score/][online calculator]]
*** Definitions
- Anemia: hgb <13 g/dl men, <12 g/dl women
- Severe renal disease: GFR <30 ml/min or HD dependent
- Any prior hemorrhage dx (all-cause)
*** risk score
| risk factor           | points |
| anemia                |      3 |
| severe renal disease  |      3 |
| age >= 75 y           |      2 |
| any prior hemorrhage  |      1 |
| diagnosed HTN         |      1 |
*** Results
- low risk 0-3 points (hemorrhage rate <1% per year 0.8%
- intermediate risk 4 points 2.6% risk
- high risk 5-10 points >5% per year risk 5.8%
*** endpoint
major hemorrhage
note all pts on warfarin
** TODO ATRIA Stroke risk score
*** References
[[http://jaha.ahajournals.org/content/2/3/e000250.full][AHA article]]
[[http://jaha.ahajournals.org/content/2/3/e000250/T3.expansion.html][Table showing point assignment]]
*** risk score
ATRIA Stroke Risk Model Point Scoring System

| Risk Factor     | Without Stroke | With Stroke |
|-----------------+----------------+-------------|
| Age, y          |                |             |
| ≥85             |              6 |           9 |
| 75 to 84        |              5 |           7 |
| 65 to 74        |              3 |           7 |
| <65             |              0 |           8 |
| Female          |              1 |           1 |
| Diabetes        |              1 |           1 |
| CHF             |              1 |           1 |
| Hypertension    |              1 |           1 |
| Proteinuria     |              1 |           1 |
| eGFR<45 or ESRD |              1 |           1 |
Possible point scores range from 0 to 12 for those without a prior stroke and from 7 to 15 for those with a prior stroke. ATRIA indicates Anticoagulation and Risk Factors in Atrial Fibrillation; CHF, congestive heart failure; eGFR, estimated glomerular filtration rate; ESRD, end‐stage renal disease.
*** Results
| Score              | events/year |
|--------------------+-------------|
| low 0-5 points     | < 1%        |
| moderate 6 points  | 1 to < 2%   |
| high 7 - 15 points | >= 2%       |
*** Outcome events
- ischemic stroke
- other thromboembolic events
** TODO SAMe-TT2R2 score
*** Reference
[[http://journal.publications.chestnet.org/article.aspx?articleid=1686270][full text]]
*** Score
| factor                 | points |
| Sex (female)           |      1 |
| Age (<60 y)            |      1 |
| Medical hx (see below) |      1 |
| Treatment (see below)  |      1 |
| Tobacco use            |      2 |
| Race (non-Caucasian    |      2 |
- Medical Hx = more than 2 of following: HTN, DM, CAD/MI, PAD, CHF, prior stroke, pulmonary disease, hepatic or renal disease.
- Treatment: interacting drugs, e.g. amiodarone
*** Results
- 0-2 Patients have high TTR (Time in Therapeutic Range)( e.g. >65%) so initiating VKA likely beneficial
- > 2 Improve education regarding AC control, or use a NOAC
* Preparing new version -- IMPORTANT!
  - [X] finish version, commit.
  - [X] git flow release start vx.y
  - [X] IMPORTANT - update build.gradle
    - [X] increment android:versionCode
    - [X] change android:versionName
  - [X] ALSO IMPORTANT - update version in About.java!!!
  - [ ] run git log --pretty=oneline and update changes/x.y.z.txt
  - [ ] git add changes/x.y.z.txt
  - [ ] update doc/description.txt
  - [ ] update screenshots - resize them with GIMP to 480 x 800.
  - [ ] git commit
  - [ ] git flow release finish vx.y
  - [ ] git push --tags origin master
  - [ ] git push origin develop
  - [ ] refresh android studio epmobile
  - [ ] make/sign epmobile.apk, save it in dev/epmobileapp/later_versions/
  - [ ] on market.android.com update product details
  - [ ] upload apk, deactivate old one
  - [ ] Tweet It! (after confirming it's on the Market)
  - [ ] DONE!
