What is the CHA2DS2-VASc score?

Updated: Apr 18, 2017
  • Author: Tarek Ajam, MD, MS; more...
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Answer

Answer

Consequently, CHADS2 was expanded to include three additional independent risk factors: vascular disease (coronary artery disease, peripheral artery disease, aortic atherosclerosis), age 65-74 years, and female sex. [8, 9, 10] This new, more inclusive scoring system is the CHA2DS2-VASc score. [11]

The CHA2DS2-VASc score better discriminated stroke risk in nonvalvular AF subjects with a baseline CHADS2 score of 0 to 1; its improved predictive ability was demonstrated in a nationwide Danish registry from 1997 to 2008. [12]  In a Swedish population with nonvalvular AF, [13] women had a moderately increased stroke risk compared with men. However, women younger than 65 years without other AF risk factors had a low risk for stroke, and it was concluded that those patients did not require OAC prophylaxis. 

The 2016 European Society of Cardiology (ESC) guidelines recommend using the CHA2DS2-VASc score to estimate stroke risk in AF patients and to start OACs in men with a score of 1 or higher and women with a score of 2 or higher. [14]  The 2014 American Heart Association/ American College of Cardiology/ Heart Rhythm Society (AHA/ACC/HRS) guidelines also recommend the CHA2DS2-VASc score for the assessment of stroke risk in paitents with nonvalvular AF. Consideration of OAC prophylaxis is recommended for patients with a score of 1 and OAC use is a definite recommendation for patients with a score of 2 or greater and for those with a history of stroke or transient ischemic attack. [15]  

Use of the CHA2DS2-VASc score to determine stroke risk in patients having cardiac surgery independent of AF has been advocated. [18] Stroke prevention versus bleeding risk in AF can be addressed if the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly) score is also calculated with the CHA2DS2-VASc score.

See Tables 3, 4, and 5, below. See also Medscape's Atrial Fibrillation CHA2DS2-VASc Score for Stroke Risk calculator.

Table 3. CHA2DS2-VASc Score and Risk Criteria (Open Table in a new window)

Score

CHA2DS2-VASc Risk Criteria

1 point

Congestive heart failure

1 point

Hypertension

2 points

Age ≥75 years

1 point

Diabetes mellitus

2 points

Stroke/Transient Ischemic Attack/Thromboembolic event

1 point

Vascular disease (prior MI, PAD, or aortic plaque)

1 point

Age 65 to 74 years

1 point

Sex category (ie, female sex)

Table 4. CHA2DS2-VASc Score and Corresponding Annual Stroke Risk (Open Table in a new window)

CHA2DS2-VASc Score

Adjusted Stroke Risk, (% per year)

0

0

1

1.3

2

2.2

3

3.2

4

4.0

5

6.7

6

9.8

7

9.6

8

6.7

9

15.2

Adjusted stroke rate scores are based on data from Lip and colleagues. [5, 8, 16, 17]  The actual rates of stroke in contemporary cohorts may vary from these estimates.

Table 5. Treatment Recommendations Based on CHA2DS2-VASc Score [15] (Open Table in a new window)

CHA2DS2-VASc Score

Recommendation

0

None

1

None or aspirin or OAC

2 or more

OAC


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