From the Guidelines
The CHADS2 score is a widely used tool to assess stroke risk in patients with atrial fibrillation, assigning points for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or TIA. The CHADS2 score is calculated as follows:
- C - Congestive heart failure (1 point)
- H - Hypertension (1 point)
- A - Age ≥75 years (1 point)
- D - Diabetes mellitus (1 point)
- S2 - Prior Stroke or TIA (2 points) The total score ranges from 0-6, with higher scores indicating greater stroke risk, as supported by studies such as 1 and 1. This score helps clinicians determine whether anticoagulation therapy is necessary, with patients having a score of 0 considered low risk, 1 as moderate risk, and 2 or higher as high risk, often warranting anticoagulation, as recommended by guidelines such as 1 and 1. Some key points to consider when using the CHADS2 score include:
- The score has been validated in multiple studies, including 1 and 1
- The score is simple and easy to use in clinical practice
- Newer scores, such as CHA2DS2-VASc, offer more refined risk stratification, as discussed in 1 and 1
- The threshold for anticoagulation therapy may vary depending on individual patient factors, such as bleeding risk and patient preferences, as noted in 1 and 1. Overall, the CHADS2 score remains a valuable tool for assessing stroke risk in patients with atrial fibrillation, and its use can help guide clinical decision-making regarding anticoagulation therapy, as supported by the evidence from 1, 1, and 1.
From the Research
Overview of the CHADS2 Scoring System
The CHADS2 scoring system is a clinical prediction rule used to estimate the risk of stroke in patients with nonvalvular atrial fibrillation, as well as in other patient populations 2, 3, 4, 5, 6.
Components of the CHADS2 Score
The CHADS2 score is calculated based on the presence or absence of the following conditions:
- Congestive heart failure
- Hypertension
- Age ≥ 75 years
- Diabetes
- Stroke or transient ischemic attack (doubled)
Calculation of the CHADS2 Score
Each condition is assigned a point value, with the exception of stroke or transient ischemic attack, which is assigned 2 points. The total score ranges from 0 to 6 points.
Clinical Applications of the CHADS2 Score
The CHADS2 score has been used to predict the risk of stroke in various patient populations, including:
- Patients with nonvalvular atrial fibrillation 2, 3, 5, 6
- Hypertensive patients without known atrial fibrillation 2
- Patients without atrial fibrillation 4
- Patients with atrial fibrillation who undergo percutaneous coronary revascularization 5
Predictive Value of the CHADS2 Score
Studies have shown that the CHADS2 score is a useful predictor of stroke risk, with higher scores indicating a greater risk of stroke 2, 3, 4, 5, 6. The score has also been shown to predict poor neurological outcome and long-term mortality in patients with atrial fibrillation-related ischemic stroke 6.
Key Findings
- The CHADS2 score is a proven tool for estimating cardioembolic risk in patients with nonvalvular atrial fibrillation 2
- The score may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation 2
- The CHADS2 score has a relatively high performance for stroke prediction in individuals without atrial fibrillation 4
- A high-risk CHADS2 score is an independent predictor of poor neurological outcome and long-term mortality in patients with atrial fibrillation-related ischemic stroke 6