What are the components of the CHA2DS2‑VA score?

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Last updated: September 20, 2026 • View editorial policy

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CHA₂DS₂-VA Score Components

The CHA₂DS₂-VA score consists of seven components that assess thromboembolic risk in atrial fibrillation, notably excluding female sex from the traditional CHA₂DS₂-VASc score. 1

Score Components and Point Values

The 2024 ESC Guidelines provide the definitive breakdown of the CHA₂DS₂-VA scoring system 1:

C - Chronic Heart Failure (1 point)

  • Symptoms and signs of heart failure regardless of left ventricular ejection fraction (LVEF)
  • Includes HFpEF, HFmrEF, and HFrEF
  • Also includes asymptomatic LVEF ≤40%

H - Hypertension (1 point)

  • Resting blood pressure >140/90 mmHg on at least two occasions, OR
  • Current antihypertensive treatment
  • Optimal BP target: 120-129/70-79 mmHg

A - Age ≥75 years (2 points)

  • Age is an independent determinant of ischemic stroke risk
  • Two points given for age 75 years or above

D - Diabetes Mellitus (1 point)

  • Type 1 or type 2 diabetes by currently accepted criteria, OR
  • Treatment with glucose-lowering therapy

S - Prior Stroke/TIA/Arterial Thromboembolism (2 points)

  • Previous thromboembolism carries highly elevated recurrence risk
  • Weighted as 2 points due to high-risk nature

V - Vascular Disease (1 point)

  • Coronary artery disease including:
    • Prior myocardial infarction
    • Angina
    • History of coronary revascularization (surgical or percutaneous)
    • Significant CAD on angiography or cardiac imaging

A - Age 65-74 years (1 point)

  • One point for age between 65 and 74 years

Key Differences from CHA₂DS₂-VASc

The critical distinction is the removal of female sex as a scoring criterion. The 2024 ESC Guidelines explicitly state this score is "without a criterion for birth sex or gender" 1. This modification reflects emerging evidence that female sex functions more as a risk modifier rather than an independent risk factor 2, with recent data showing attenuated sex-based differences in stroke risk over time 3.

Clinical Application

Oral anticoagulation is recommended for CHA₂DS₂-VA score ≥2 and should be considered for score of 1 1. The score ranges from 0 to 9 points total, with higher scores indicating progressively elevated thromboembolic risk requiring anticoagulation therapy.

Important Caveats

  • Beyond these seven components, consider additional risk modifiers including cancer, chronic kidney disease, ethnicity (Black, Hispanic, Asian), and biomarkers (troponin, BNP) 1
  • Certain conditions mandate anticoagulation regardless of score: hypertrophic cardiomyopathy and cardiac amyloidosis require OAC independent of CHA₂DS₂-VA calculation 1
  • Periodic reassessment of thromboembolic risk is essential to ensure appropriate anticoagulation decisions 1

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.