Demographic and Comorbidities

Please answer all questions below if you have any of these conditions or characteristics.

Heart Failure

Recent Heart Failure Exacerbation or EF≤40% 



Age 65-74


Age 75+


Diabetes Mellitus

Use of oral or injection medications 

Prior Stroke or TIA

Including any thromboembolism 

Vascular Disease

Prior myocardial infarction, peripheral arterial disease or aortic plaque 



Renal Dysfunction

Dialysis, renal transplant or Serum Cr ≥ 2.25 mg/dL  

Liver Dysfunction

Cirrhosis or elevated liver function tests 

Prior Hemorrhagic Stroke


Prior Major Bleeding Event




Antiplatelet Medication Use

Includes aspirin and NSAIDs 

Heavy Alcohol Use

>16 beers OR >10 glasses of wine per week 

Mechanical Valve Replacement


Click “Next” after you enter all responses.

About Us

SVM: A community of vascular clinicians and scientists
The Society for Vascular Medicine is a professional organization that was founded in 1989 to foster a broad mission: to improve the integration of vascular biological advances into medical practice, and to maintain high standards of clinical vascular medicine.


The Society for Vascular Medicine
111 West Jackson Blvd., 14th Floor
Chicago, IL 60604 USA
Phone +1.847.686.2232