Congestive heart failure (+1)
Or left ventricular systolic dysfunction
Hypertension (+1)
Age ≥ 75 years (+2)
Diabetes Mellitus (+1)
Stroke/TIA/Thromboembolism (+2)
Vascular disease (+1)
e.g., prior MI, peripheral artery disease, or aortic plaque
Age 65-74 years (+1)
Female (+1)
CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk
The CHA₂DS₂-VASc score is an essential clinical prediction rule used to estimate the annual risk of ischemic stroke in patients diagnosed with non-valvular atrial fibrillation (AF). This score is a critical tool for guiding decisions about the initiation of oral anticoagulation therapy.
Scoring Criteria
The acronym CHA₂DS₂-VASc represents the key clinical risk factors, with points assigned for each:
| Risk Factor | Points | Mnemonic |
|---|---|---|
| Congestive heart failure (or LV dysfunction) | +1 | C |
| Hypertension | +1 | H |
| Age ≥ 75 years | +2 | A₂ |
| Diabetes Mellitus | +1 | D |
| Prior Stroke, TIA, or Thromboembolism | +2 | S₂ |
| Vascular disease (MI, PAD, aortic plaque) | +1 | V |
| Age 65-74 years | +1 | A |
| Sex category (Female) | +1 | Sc |
Note: The maximum possible score is 9.
Clinical Interpretation and Management
- Score of 0 (males) or 1 (females): Very low risk. Anticoagulation therapy is generally not recommended.
- Score of 1 (males) or 2 (females): Low to moderate risk. Antithrombotic therapy with an oral anticoagulant should be considered.
- Score ≥ 2 (males) or ≥ 3 (females): Moderate to high risk. Oral anticoagulation is strongly recommended.
It's a valuable tool for shared decision-making, allowing clinicians and patients to weigh the benefits of stroke prevention against the risks of bleeding associated with anticoagulants.
References
- Lip, G. Y., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. (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.
- January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., ... & Yancy, C. W. (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 74(1), 104-132.
- Olesen, J. B., Torp-Pedersen, C., Hansen, M. L., & Lip, G. Y. (2012). The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thrombosis and haemostasis, 107(06), 1172-1179.
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