X

CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk

Congestive heart failure

The CHA2DS2-VASc score for atrial fibrillation

The updated version of CHADS2 score, both scores are clinical rules that are used to predict the risk of stroke in patients with non-rheumatic atrial fibrillation (AF). AF is a common and high-risk heart arrhythmia allied with thromboembolic stroke.

This score is used to estimate if a person needs to be treated with anticoagulation therapy or antiplatelet therapy. Due to AF the blood flow into the upper chamber of the heart which can cause the formation of mural thrombus which can dislodge into blood, ultimately reaching the brain, causing a blood clot, and cause a stroke.


CHADS2 and CHA2DS2-VASc

Both CHADS2 and CHA2DS2-VASc are co-related but CHADS includes fewer risk factors.

Here is the interpretation and difference between both scores:

CHADS2

Points are added together according to conditions to estimate the risk of stroke; where 0 is normal.

  • (C) Congestive heart failure- 1 point
  • (H) Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)- 1 point
  • (A) Age ≥75 years- 1 point
  • (D) Diabetes mellitus- 1 point
  • (S2) Prior Stroke or TIA or Thromboembolism- 2 points

Each point is added and the risk of stroke is calculated. Here is the annual risk of stroke according to the CHADS2 score.

CHA2DS2-VASc

This is the modified version of CHADS2 which contains more conditions that increase the risk of stroke. CHA2DS2-VASc is now used as this gives a better stratification in low-risk patients as compared to CHADS2.

  • (C) Congestive heart failure (or left ventricular systolic dysfunction)- 1 point
  • (H) Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)- 1 point
  • (A2) Age ≥75 years- 2 points
  • (D) Diabetes Mellitus- 1 point
  • (S2) Prior Stroke or TIA or thromboembolism- 2 points
  • (V) Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)- 1 point
  • (A) Age 65–74 years- 1 point
  • (S2) Sex category (i.e. female sex)- 1 point

CHA2DS2-VASc is the extended version which includes vascular diseases (1 point) and extra age group with additional 2 points.

The maximum CHADS2 is 6 while the maximum CHA2DS2-VASc is 9.

Here is the annual stroke risk according to the CHA2DS2-VASc score:


Treatment

Treatment is done according to the CHA2DS2-VASc score. Score 0 for males and 1 for females is normal and no treatment is needed. Higher the score more the risk increases and treatment is required.  CHA2DS2-VASc score guideline has been used by the European Society of Cardiology in 2012 for atrial fibrillation management.

National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC) recommended the use of CHA2DS2-VASc score. According to their guideline if a person’s score is CHA2DS2-VASc score is 2 or more then the patient is recommended with oral anticoagulation therapy (OAC) with the drug a Vitamin K Antagonist or with non-VKA oral anticoagulant drugs like edoxaban, apixaban, dabigatran, or rivaroxaban.

For patients having 0 (male) and 1 (female) CHA2DS2-VASc score then the recommended therapy is non-anticoagulant.

Male patients have a CHA2DS2-VASc score of 1 the considerable therapy is antithrombotic therapy with OAC. A single stroke can increase the risk of further strokes and mortality, with oral anticoagulation stroke risk decreases as compared to aspirin or no treatment.  As some of the mentioned guidelines above, there are various guidelines and methodological approaches as well that are considered worldwide.


Anticoagulation

Here is a list of different CHA2DS2-VASc score with treatment:

CHA2DS2-VASc score: 0 (male), 1 (female)

Risk: Low

Anticoagulant therapy: No anticoagulant therapy

Considerations: No anticoagulant therapy

CHA2DS2-VASc score: 1 (male)

Risk: Moderate

Anticoagulant therapy: Oral anticoagulant should be considered

Considerations: Oral anticoagulant, with well-controlled Vitamin K Antagonist (VKA, e.g. warfarin with time in therapeutic range >70%), or a non-VKA Oral Anticoagulant (NOAC, e.g. dabigatran, rivaroxaban, edoxaban or apixaban)

CHA2DS2-VASc score: 2 or greater

Risk: High

Anticoagulant therapy: Oral anticoagulant is recommended

Considerations: Oral anticoagulant, with well-controlled Vitamin K Antagonist (VKA, e.g. warfarin with time in therapeutic range >70%), or a non-VKA Oral Anticoagulant (NOAC, e.g. dabigatran, rivaroxaban, edoxaban or apixaban)

On the basis of ESC guidelines on atrial fibrillation, if a person is having CHA2DS2-VASc score of 2 or greater than the oral anticoagulation is preferred or recommended.

Patients recommended with oral anticoagulation, Vitamin K Antagonist and Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) drugs are recommended according to the SAMe-TT2R2 score which helps making the right oral anticoagulant drug.


CHA2DS2-VASc score Calculator

The CHA2DS2-VASc score is an important factor that needed to be checked regularly to avoid any stroke risk or any complication in the future.

You can check your CHA2DS2-VASc score while going to a clinic or you can use our online calculator to easily find out your CHA2DS2-VASc score by providing some information which are:

  • Gender
  • Age
  • CHF ( congestive heart failure)
  • Hypertension history
  • Stroke/TIA/Thromboembolism history
  • Vascular disease history
  • History of diabetes

Our tool is not only just precise but also user-friendly that can be used by any person with ease. After providing sufficient information just click on “calculate” and the results will come to you in seconds.

Need Custom Calculator?

With Over Online Tools, eCalculator.co Helping Millions of Students, Teachers, Businessmen & Nutritionists Every Month.

Related Articles