CHA2DS2-VASc Score

 

 

  Risk Factor

   Score  

 C

 Congestive heart failure / Left ventricular dysfunction

1

 H

 Hypertension - high blood pressure

1

 A2

 Age > 75 years

2

 D

 Diabetesmellitus

1

 S2 

 Stroke / TIA / TE (thromboembolism)

2

 V

 Vascular disease - coronary artery disease (CAD) 
 Myocardial infarction (heart attack)
 Peripheral artery disease (PAD)
 Aortic plaque

1

 A

 Age 65 - 74

1

 Sc  

 Sex category - Female gender

1

Table 1: 2009 Birmingham Schema, CHA2DS2-VASc Scoring System
Source: Adapted from Table 1(b), 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

In the CHA2DS2-VASc Scoring System above, high risk equals a score of two or greater.

 

CHA2DS2-VASc Score

Patients (n = 7329)

Adjusted Stroke rate (%/year)

0

1

0

1

422

1.3

2

1230

2.2

3

1730

3.2

4

1718

4.0

5

1159

6.7

6

679

9.8

7

294

9.6

8

82

6.7

9

14

15.2

 

Table 2: Predicted stroke rate.

The flow chart below is an additional way of identifying who should be on anticoagulants.

 

 Q1 

 Age 75 or greater?

 Yes->OAC

 No->Go to Q2

 Q2

 History of stroke, TIA or  
 embolism?

 Yes->OAC

 No->Go to Q3

 Q3

 Gender?

 Male
 ->Go to Risk Factors

 Female
 ->Go to Risk Factors

 

  Risk Factors

  • Age 65-74
  • Hypertension
  • Vascular disease - coronary artery disease (CAD)
    Myocardial infarction (heart attack)
    Peripheral artery disease (PAD) or 
    Aortic plaque
  • Heart failure
  • Decreased ejection fraction
  • Diabetes mellitus

 Male+two or more risk factors
 ->OAC

 Female+any other risk factor 
 ->OAC

 OAC = Oral Anticoagulant

Table 3: Flow Chart for Use of Oral Anticoagulation (OAC) for Stroke Prevention in Atrial Fibrillation
Source: Adapted from Figure 1, 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

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