CHA2DS2-VASc Score for non Rheumatic Atrial Fibrillation Stroke Risk

Please note: This score calculates an estimated annual stroke risk for people who have a diagnosis of atrial fibrillation. This score should be NOT be used in patients with Rheumatic heart disease or a prosthetic heart valve and should be used as a guide only and because variation in circumstances and medical conditions does not replace a formal assessment by a qualified medical healthcare professional.

Age?
  • +0
  • +1
  • +2
Congestive Heart Failure History? +1
Hypertension History? +1
Stroke/TIA/Thromboembolism History? +2
Vascular Disease History? (previous MI, peripheral arterial disease or aortic plaque) +1
Diabetes Mellitus? +1
Female? +1
Score

The CHA2DS2VASc AF risk stratification score is an updated version of the previous CHADS2 score. It provides an estimated annual stroke risk for people with atrial fibrillation based on registry data.

The more recent CHA2DS2VASc risk stratification score has been recommended by the European Society of Cardiology in their latest 2012 Atrial Fibrillation guidelines because of the score's ability to differentiate very low risk patients.

Since the score is based on registry data, some of the definitions are somewhat imprecise - for example what defines 'diabetes mellitus'? We have attempted to amalgamate the data available in the literature to generate definitions to help you use this risk score:

Cardiac failure     Moderate-severe left ventricular dysfunction (or ejection fraction < 40%) or at least 2 hospital admissions requiring diuretics.

Hypertension        BP > 160/100mmHg or on at least one antihypertensive agent.

Diabetes mellitus  On treatment (Insulin or oral hypoglycaemics) or random blood glucose >11mmol/L.

Vascular disease   Ischaemic heart disease, peripheral vascular disease or aortic atheroma.

Some authors have recommended using this score in conjunction with the HAS-BLED Score to help determine if anticoagulation is in the best interest of a particular patient.

 

References

Gage B, Waterman A, et al. Validation of clinical classification schemes for predicting stroke. JAMA 2001; 285(22):2864-70

Lip G, Nieuwlaat R, Pisters R, Lane D, Crijns H. 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(2):263-72

Olesen J, Lip G, Hansen M, Hansen P, Tolstrup J, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 2011; 342:d124

Lip G, Frison L, et al. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. JACC 2011; 57(2)173-80