From the Guidelines
The CHA₂DS₂-VASc score is the most recommended clinical prediction tool for estimating stroke risk in patients with non-valvular atrial fibrillation, as evidenced by the 2023 ACC/AHA/ACCp/HRS guideline 1. The score assigns points for various risk factors: Congestive heart failure (1 point), Hypertension (1 point), Age ≥75 years (2 points), Diabetes (1 point), prior Stroke/TIA/thromboembolism (2 points), Vascular disease (1 point), Age 65-74 years (1 point), and Sex category (female) (1 point).
Key Components of the CHA₂DS₂-VASc Score
- Congestive heart failure or left ventricular ejection fraction ≤40% (1 point)
- Hypertension (1 point)
- Age ≥75 years (2 points)
- Diabetes mellitus (1 point)
- Stroke, transient ischemic attack, or thromboembolism (2 points)
- Vascular disease (1 point)
- Age 65–74 years (1 point)
- Sex category (i.e., female sex) (1 point) For patients with a score of 0, antithrombotic therapy is not recommended 1. For patients with a score of 1, antithrombotic therapy with oral anticoagulation or antiplatelet therapy is recommended, but preferably oral anticoagulation 1. For patients with a score of 2 or higher, oral anticoagulation is strongly recommended 1, typically with direct oral anticoagulants (DOACs) like apixaban, rivaroxaban, dabigatran, or edoxaban, or with warfarin (target INR 2-3), as supported by the most recent guideline 1. The higher the score, the greater the stroke risk, with annual stroke risks ranging from about 0.2% with a score of 0 to over 12% with scores ≥9, highlighting the importance of using the CHA₂DS₂-VASc score to guide anticoagulation therapy decisions 1.
From the Research
CHADS Vasc Score Overview
- The CHA2DS2-VASc score is a modification of the CHADS2 score that aims to improve stroke risk prediction in patients with atrial fibrillation (AF) by adding three risk factors: age 65-74, female sex, and history of vascular disease 2.
- The score is used to guide anticoagulation therapy in patients with non-valvular atrial fibrillation (NVAF) 3, 4.
Prediction of Ischaemic Stroke
- The CHA2DS2-VASc score has been shown to predict ischaemic stroke in patients with or without atrial fibrillation, with modest discrimination ability 5, 4.
- A meta-analysis found that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF 4.
- The score has been found to be associated with risk of ischemic stroke, thromboembolism, and death in patients with heart failure with or without AF 5.
Clinical Utility
- The clinical utility of the CHA2DS2-VASc score in patients with heart failure remains to be determined 5.
- The score may be useful in identifying patients with a low annual risk of stroke who may not require anticoagulant treatment 2.
- Novel risk factors and alternative models for stroke prediction, such as the TIMI-AF score, ATRIA score, and GARFIELD-AF scores, may further assist in decision-making for anticoagulation therapy 6.