archetype (adl_version=1.4; uid=362f6dc8-d03a-4efe-91db-5f5c83affb54)
	openEHR-EHR-OBSERVATION.atria_bleeding_risk.v0

concept
	[at0000]	-- ATRIA bleeding risk score
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			author = <
				["name"] = <"Dennis Forslund">
				["organisation"] = <"Cambio Healtcare Systems">
			>
		>
	>
description
	original_author = <
		["name"] = <"Eneimi Allwell-Brown">
		["organisation"] = <"Cambio Healthcare Systems">
		["email"] = <"models@cambiocds.com">
		["date"] = <"2017-02-13">
	>
	details = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			purpose = <"Att hos patienter med förmaksflimmer uppskatta risken för warfarin-associerad blödning.">
			use = <"Använd för registrering av data i enlighet med Anticoagulation and Risk Factors in Atrial Fibrillation Score (ATRIA). Instrumentet baseras på förekomst av följande faktorer:

- Anemi
- Svår njursjukdom (eGFR <30 ml/min alternativt dialys)
- Ålder ≥75 år
- Tidigare blödning
- Hypertoni

Resultatet uppgår till maximalt 10p, och tolkas med avseende på risk för warfarin-associerad blödning enligt:
<4p - låg risk (0,8%)
4p - mellanrisk (2,6%)
>4p - hög risk (5,8%)

Utfallet definieras som blödning med dödlig utgång, behov av minst två enheter blodtransfusion eller blödning i kritisk anatomisk lokal såsom intrakraniellt eller retroperitonealt.

Instrumentet kan användas som stöd för beslut kring huruvida behandling med warfarin är lämplig samt för att utvärdera behandling med antikoagulantia hos patienter med förmaksflimmer. Utvärdering av poängen görs med openEHR-EHR-EVALUATION.atria_bleeding_risk.v1.">
			keywords = <"antikoagulantia", "warfarin", "waran", "blödning", "blödningsrisk", "kardiologi", "förmaksflimmer">
			misuse = <"Endast avsedd för patienter med förmaksflimmer.">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the results for each component parameter and their total sum for the ATRIA bleeding risk score.
">
			use = <"Use to record the results for each component parameter and their total sum for the ATRIA bleeding risk score.">
			keywords = <"anticoagulation", "atrial fibrillation", "warfarin", "major hemorrhage", "hemorrhage risk", "cardiology">
			misuse = <"Do not use if the patient does not have atrial fibrillation.">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Heather Leslie, Atomica Informatics, Australia", ...>
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE. A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. Journal of the American College of Cardiology. 2011 Jul 19;58(4):395-401.

Apostolakis S, Lane DA, Guo Y, Buller H, Lip GY. Performance of the HEMORR 2 HAGES, ATRIA, and HAS-BLED Bleeding Risk–Prediction Scores in Patients With Atrial Fibrillation Undergoing Anticoagulation: The AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) Study. Journal of the American College of Cardiology. 2012 Aug 28;60(9):861-7.

Roldán V, Marín F, Fernández H, Manzano-Fernandez S, Gallego P, Valdés M, Vicente V, Lip GY. Predictive value of the HAS-BLED and ATRIA bleeding scores for the risk of serious bleeding in a “real-world” population with atrial fibrillation receiving anticoagulant therapy. CHEST Journal. 2013 Jan 1;143(1):179-84.">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"8E08250617145FD91DF48B6B3356522D">
		["build_uid"] = <"48b9c087-ad9c-47cd-aec5-7a3da91247e1">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- ATRIA bleeding risk score
		data matches {
			HISTORY[at0001] matches {    -- Event Series
				events cardinality matches {1..*; unordered} matches {
					POINT_EVENT[at0002] occurrences matches {0..1} matches {    -- Any point in time event
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- Anemia
										value matches {
											0|[local::at0019],
											3|[local::at0020]
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {    -- Severe renal disease
										value matches {
											0|[local::at0017],
											3|[local::at0018]
										}
									}
									ELEMENT[at0006] occurrences matches {0..1} matches {    -- Age ≥75 years
										value matches {
											0|[local::at0015],
											2|[local::at0016]
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {    -- Prior hemorrhage diagnosis
										value matches {
											0|[local::at0013],
											1|[local::at0014]
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- History of hypertension
										value matches {
											0|[local::at0011],
											1|[local::at0012]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..10|}
											}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0021] matches {    -- Item tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0022] occurrences matches {0..*} matches {    -- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"ATRIA bleeding risk score">
					description = <"An assessment score used to predict the risk of warfarin-associated haemorrhage and guide physician decision-making regarding warfarin use in atrial fibrillation.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any point in time event">
					description = <"Default, unspecified point in time event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Anemia">
					description = <"Presence of hemoglobin concentration <13 g/dl (male) or <12 g/dl (female).">
				>
				["at0005"] = <
					text = <"Severe renal disease">
					description = <"Presence of estimated glomerular filtration rate (eGFR) <30 ml/min or dialysis-dependent.">
				>
				["at0006"] = <
					text = <"Age ≥75 years">
					description = <"Individual is 75 years or older.">
				>
				["at0007"] = <
					text = <"Prior hemorrhage diagnosis">
					description = <"Any prior hemorrhage diagnosis (internal or external hemorrhage).">
				>
				["at0008"] = <
					text = <"History of hypertension">
					description = <"History of diagnosed hypertension.">
				>
				["at0009"] = <
					text = <"Total score">
					description = <"Sum of points assigned for each of the component parameters.">
				>
				["at0011"] = <
					text = <"No">
					description = <"*">
				>
				["at0012"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0013"] = <
					text = <"No">
					description = <"*">
				>
				["at0014"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0015"] = <
					text = <"No">
					description = <"*">
				>
				["at0016"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0017"] = <
					text = <"No">
					description = <"*">
				>
				["at0018"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0019"] = <
					text = <"No">
					description = <"*">
				>
				["at0020"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0021"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0022"] = <
					text = <"Extension">
					description = <"Additional information required to capture local content or to align with other reference models/formalisms.">
					comment = <"For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.">
				>
			>
		>
		["sv"] = <
			items = <
				["at0000"] = <
					text = <"ATRIA bleeding risk score">
					description = <"Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding risk score uppskattar blödningsrisk hos warfarinbehandlade patienter med förmaksflimmer baserat på fem faktorer. En poäng om <4 indikerar låg risk, 4p mellanrisk och >4p hög risk för blödning. Utfallet definieras som blödning med dödlig utgång, behov av minst två enheter blodtransfusion eller blödning i kritisk anatomisk lokal såsom intrakraniellt eller retroperitonealt. ">
				>
				["at0001"] = <
					text = <"*Event Series(en)">
					description = <"*@ internal @(en)">
				>
				["at0002"] = <
					text = <"*Any point in time event (en)">
					description = <"*Default, unspecified point in time event which may be explicitly defined in a template or at run-time. (en)">
				>
				["at0003"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0004"] = <
					text = <"Anemi">
					description = <"(Per definition.) Hemoglobin-koncentration <13 g/dl (man) eller <12 g/dl (kvinna).">
				>
				["at0005"] = <
					text = <"Svår njursjukdom">
					description = <"eGFR <30 ml/min eller dialyskrävande">
				>
				["at0006"] = <
					text = <"Ålder ≥75 år">
					description = <"Patienten är minst 75 år gammal.">
				>
				["at0007"] = <
					text = <"Tidigare blödning">
					description = <"Tidigare intern eller extern (större) blödning.">
				>
				["at0008"] = <
					text = <"Hypertoni">
					description = <"Diagnosticerad hypertoni.">
				>
				["at0009"] = <
					text = <"Resultat">
					description = <"*Sum of points assigned for each of the component parameters. (en)">
				>
				["at0011"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0012"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0013"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0014"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0015"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0016"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0017"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0018"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0019"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0020"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0021"] = <
					text = <"*Item tree (en)">
					description = <"@ internal @">
				>
				["at0022"] = <
					text = <"*Extension (en)">
					description = <"*Additional information required to capture local content or to align with other reference models/formalisms. (en)">
					comment = <"*For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents. (en)">
				>
			>
		>
	>