CHA2DS2-VASc Score

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Estimating the Risk of Stroke in Atrial Fibrillation [AF]: The CHA₂DS₂-VASc Score

Introduction:

The CHA₂DS₂-VASc score is a clinical prediction rule for estimating the risk of stroke in patients with non-valvular Atrial Fibrillation [AF]. It is used to guide whether a particular patient may benefit from anticoagulation. It is based on the CHADS₂ score but includes three additional risk factors for stroke: Age 65-74; female sex and a history of vascular disease. These additional risk factors are believed to more accurately predict the risk of stroke in patients with a with a CHADS₂ score of 0 or 1 and therefore, who may benefit from anticoagulation.

CHA₂DS₂-VAS Score:

The criteria that comprise the CHA₂DS₂-VASc score are summarised below:

[C] Congestive Heart Failure
	1 Point
[H] Hypertension [Hypertension of any severity]
	1 Point
[A₂] Age
	<65 yrs 0 Points
	65-74 yrs 1 Point
	≥ 75 yrs 2 Points
[D] Diabetes
	1 Point
[S₂] Prior Stroke or TIA or Thromboembolism
	2 Points
[V] Vascular Disease
	1 Point
[Sc] Sex - Female
	1 Point

Score

[Max score 9 points]

CHA₂DS₂-VASc Score	Stroke Risk [%]
0	0
1	1.3
2	2.2
3	3.2
4	4.0
5	6.7
6	9.8
7	9.6
8	12.5
9	15.2

CHA₂DS₂-VASc Score	Stroke Risk
≥2	High
1	Intermediate
0	Low

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Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com, assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

1. Prospective studies have shown that patients with an acute stroke and a significantly reduced eGFR have a higher mortality in comparison to those with moderate renal dysfunction.
The R₂CHADS₂ score was based on a sub-analysis of the ROCKET AF study and the addition of 2 additional points in patients with moderate renal dysfunction, significantly improved its predictive value. However, there are limitations to this study and subsequent analyses did not show any additive value when added to either the CHADS₂ or CH₂ADS₂-VASc scores.

2. Patients should undergo a bleeding risk evaluation before commencing anticoagulation. A number of such algorithms exist for establishing this - click HERE to access these algorithms.

3. The P₂-CHA₂DS₂-VASc score is based on the CHA₂DS₂-VASc score but includes an additional variable - an abnormal P wave axis derived from the ECG.

LINKS & References

1. Lip GY, Nieuwlaat R, et al. 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. 2010; 137: 263-72.

2. Lip GY. Using the CHADS₂ and CHA₂DS₂-VASc scores for stroke risk prediction as well as the identification of stroke outcomes and cardiac complications in patients with and without atrial fibrillation. Cerebrovasc Dis. 2013; 36: 281-2.

3. Lip GY. The CHA₂DS₂-VASc score for stroke risk stratification in patients with atrial fibrillation: a brief history. European Heart Journal. 2015.

4. Maheshwari A, Norby FL, et al. Refining Prediction of Atrial Fibrillation-Related Stroke Using the P₂-CHA₂DS₂-VASc Score. Circulation. 2019; 139: 180-91.

5. Hart RG, Pearce LA, et al. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Annals of Internal Medicine. 2007; 146: 857-67.

6. Olesen JB, Lip GY, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011; 342: d124.

7. Chao TF, Liu CJ, et al. Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians? Heart rhythm : the official journal of the Heart Rhythm Society. 2016; 13: 46-53.

8. Friberg L, Rosenqvist M, et al. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. European heart journal. 2012; 33: 1500-10.

9. Consider a PUBMED search to explore other key references in this area.

10. Click HERE to access the NICE guidelines on Atrial Fibrillation.