| Course | PA 518 Comp Clin Mod Cardiovascular |
|---|---|
| Week | 7 |
| Paper type | Stroke risk scoring memo |
| Length | About 710 words, 4 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 518 Week 7
Memorandum
To: Dr. Alvarez, attending cardiologist
From: PA student, observation unit
Date: Day 2 of observation
Re: Anticoagulation for paroxysmal atrial fibrillation in A.K.
Why This Memo
On the night after the stress test, telemetry recorded atrial fibrillation for about six hours, from 23:10 to 05:05, with rates of 100 to 130. A.K. felt a fluttering for part of it and returned to sinus rhythm without treatment. The stress study earlier that day showed normal perfusion with no fixed or reversible defect. This memo sets out the stroke and bleeding scores and gives a position on anticoagulation for you to review before the discharge conversation.
The Patient, Compressed to the Scores
Age 64 (65 in two months). Male. Hypertension, treated. Type 2 diabetes. No heart failure; ejection fraction 55 percent on last year's echo. No prior stroke or transient ischemic attack. No known vascular disease; today's perfusion study is normal. A bleeding duodenal ulcer in 2019 that required transfusion of two units; Helicobacter pylori treated. Takes naproxen 500 mg most days for knee pain. Kidney function: eGFR 52. Alcohol: two or three beers on weekends. Blood pressure on the unit 132 to 146 systolic.
Both Sets of Inputs
Table 1
Stroke and Bleeding Score Inputs Shown Side by Side
| CHA2DS2-VASc item | Points | HAS-BLED item | Points | |
|---|---|---|---|---|
| Heart failure | 0 | Uncontrolled hypertension (systolic above 160) | 0 | |
| Hypertension | 1 | Abnormal kidney or liver function | 0 | |
| Age 75 or older | 0 | Prior stroke | 0 | |
| Diabetes | 1 | Bleeding history or predisposition | 1 | |
| Prior stroke, TIA or embolism | 0 | Labile INR | 0 | |
| Vascular disease | 0 | Age over 65 | 0 | |
| Age 65 to 74 | 0 | Drugs (antiplatelet or NSAID) or alcohol | 1 | |
| Female sex | 0 | |||
| Total | 2 | Total | 2 |
Note. Note. CHA2DS2-VASc from Lip et al. (2010); HAS-BLED from Pisters et al. (2010). Kidney function counts in HAS-BLED only with dialysis, transplant or a creatinine of 2.26 mg/dL or more.
The Two Totals Held Together
The stroke score of 2 places A.K. in the group for which the atrial fibrillation guideline recommends oral anticoagulation, since men qualify from a total of 2 upward (Joglar et al., 2024). The bleeding score of 2 is not high, and the guideline advises against using a bleeding score by itself as a reason to withhold anticoagulation. Instead it recommends using the score to find bleeding risks that can be changed. In A.K.'s case one of the two bleeding points, the naproxen, can be removed. The other, the ulcer, was treated and has not recurred.
The Tipping Consideration
The consideration that carries most weight for this patient is that the stroke score is about to rise. In two months A.K. turns 65 and gains a point for age, which takes the total to 3. The decision is therefore not whether anticoagulation will be indicated, but whether to begin it now, with the naproxen stopped first, or to wait. The bleeding risk falls once the naproxen stops, and the stroke risk rises with age, so the balance tips further toward treatment over time rather than away from it.
The Patient's Own View
A.K. said clearly that they do not want a blood thinner. An older brother had a brain bleed on warfarin eight years ago and was left unable to speak clearly. A.K. understood that the newer drugs carry less risk of brain bleeding than warfarin but said, "I'd rather take my chances with the heart than end up like him." A.K. agreed to stop the naproxen and to try acetaminophen and a knee injection instead.
Position With Conditions
Recommended: a direct oral anticoagulant such as apixaban at the standard dose, since A.K. does not meet the dose-reduction criteria, together with stopping naproxen and adding a proton pump inhibitor given the ulcer history. This position stands if A.K. agrees after a full conversation. If A.K. continues to decline, the decision is documented as an informed refusal, the naproxen is still stopped, and the question is revisited at the cardiology visit after the 65th birthday, when the score rises. Aspirin is not offered as a substitute, because it gives little stroke protection and still causes bleeding.
Requested of You
Please review the scoring and lead the conversation with A.K. before discharge, ideally with the family member A.K. has asked to be present.
References
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., . . . Van Wagoner, D. R. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149(1), e1-e156. https://doi.org/10.1161/CIR.0000000000001193
Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010). 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, 137(2), 263-272. https://doi.org/10.1378/chest.09-1584
Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010). A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest, 138(5), 1093-1100. https://doi.org/10.1378/chest.10-0134
What the PA 518 Week 7 assignment asks for
The seventh week asks for a memo comparing a stroke risk score with a bleeding risk score for a patient with atrial fibrillation. Head the memo with the reader, the writer, the date and a subject line, then open with why you are writing and what decision the reader faces. Compress the patient to the features the two tools use. Show both scores with every input displayed, including zeros, side by side or in sequence. Then compare the totals and explain which consideration carries more weight for this person, citing the guideline's view on how bleeding scores should be used. Record the patient's own stated view in their words where the case gives it. Close with a recommendation phrased as a position with conditions, including what happens if the patient declines. State what you are asking the reader to do.
Inside the PA 518 Week 7 example
The memo is addressed to the attending cardiologist and opens with six hours of atrial fibrillation at rates of 100 to 130 the night after a normal perfusion study. A compressed history lists only score inputs, from age 64 to daily naproxen and a 2019 bleeding ulcer. Table 1 shows every CHA2DS2-VASc and HAS-BLED item side by side, each totaling 2, citing Lip and Pisters. The comparison cites the 2023 AF guideline: anticoagulation is recommended at this stroke score, and bleeding scores should identify fixable risks rather than justify withholding treatment. The tipping consideration is that A.K. turns 65 in two months. A.K.'s fear after a brother's warfarin-related brain bleed is quoted. The position recommends apixaban, stopping naproxen and a proton pump inhibitor, with a documented refusal pathway and no aspirin substitute.
Where the points sit in the PA 518 Week 7 rubric
The heaviest marks on this memo go to the comparison itself. A memo that reports two totals and stops, without saying which consideration matters more for this patient, loses the largest share. Faculty next check the inputs: every item of both scores must be shown, and miscoding an item, such as counting kidney disease in HAS-BLED below the defined threshold, is a significant deduction. Credit rises when the memo uses the bleeding score as the guideline intends, to find modifiable risks. The patient's view earns its own marks when recorded in specific terms rather than as declined. The recommendation is graded on whether it is a clear position with conditions. Memo format, brevity and a stated request to the reader complete the expected structure, with both scores and the guideline cited.
PA 518 Week 7 help: mistakes that cost points
Students often lose marks on this memo by treating the two scores as competing verdicts instead of tools with different jobs. Send your case and the reader your memo is addressed to, and the custom sample will compress the patient to the score inputs, show every item of both tools and compare the totals under the guideline your course uses. It identifies which bleeding risks can be changed and which consideration tips the decision for your patient. Where your case includes the patient's own wishes, they are recorded in plain terms. The recommendation is written as a position with conditions, including what happens if the patient declines. If your section wants a letter to the patient instead, the sample adjusts. Check each scored item against your case before you adapt the memo.
Get a PA-518 Week 7 example written to your instructions
Send the case, both tools your syllabus names and the memo template your section publishes, and a custom example is written into it and returned within 24 to 48 hours, the first one free. Attach the rubric page as well where it weights the comparison separately from the two scores, because the proportions of the memo follow from how those rows are split.
More PA 518 papers and MPAS samples
- PA 518 Week 1: Pretest Likelihood Discussion Post
- PA 518 Week 2: ECG Interpretation Drill
- PA 518 Week 3: Pretest Probability Worksheet
- PA 518 Week 4: HEART Score Risk Sheet
- PA 518 Week 5: Troponin Trend Reasoning
- PA 518 Week 6: Stress Test Selection Rationale
- PA 518 Week 8: Reperfusion Timing Brief
- PA 516 Week 7: Sinus Imaging Rationale
- PA 514 Week 7: Stop Date Justification
- PA 512 Week 7: Tumor Marker Monitoring Brief
- PA 510 Week 7: Biopsy Site Justification
PA 518 Week 7 questions, answered
How long should the memo run?
Most sections publish a limit, and where none appears a page or two carries the work. Size is not what separates these. A memo showing both sets of inputs and spending the rest of its space on the comparison reads as finished at almost any length, while one spending everything on the second score reads as unfinished at any.
Can the memo end without a recommendation?
Rarely. These rubrics almost always carry a row for a stated position, and a document laying out both risks and then handing the decision back is marked as unfinished. What is allowed, and usually rewarded, is a position given with its conditions: what would have to change for the balance to move, and when somebody ought to look again.
Ours wants a letter to the patient instead.
The argument underneath is the same and the surface changes completely. Both risks still have to be worked, but the letter carries the comparison in ordinary language and moves the inputs into a plain sentence or an attachment. Send the format your section named, with its reading level where one is published, and the example is written to it.
Where can I find a free PA 518 Week 7 sample paper?
This page carries the complete PA 518 Week 7 memo comparing a CHA2DS2-VASc of 2 and a HAS-BLED of 2, with the patient's own view and a conditional position.
What tips the decision in the PA 518 Week 7 memo?
A.K. turns 65 in two months, which adds a point to the stroke score, while stopping naproxen removes a bleeding point, so the balance moves further toward anticoagulation.