From the Guidelines
The EHRA score is a clinical tool used to assess and quantify symptoms in patients with atrial fibrillation, categorizing them into four classes based on their impact on daily activities. The score is used to evaluate common atrial fibrillation symptoms including palpitations, fatigue, dizziness, dyspnea, chest pain, and anxiety. According to the 2024 ESC guidelines for the management of atrial fibrillation 1, evaluating the impact of AF-related symptoms is recommended before and after major changes in treatment to inform shared decision-making and guide treatment choices. The EHRA score helps guide clinical decision-making regarding rate control versus rhythm control strategies and helps determine when more aggressive interventions might be needed.
Some key points about the EHRA score include:
- It categorizes symptoms into four classes: EHRA I (no symptoms), EHRA II (mild symptoms), EHRA III (severe symptoms), and EHRA IV (disabling symptoms)
- The score evaluates the impact of symptoms on daily activities
- Healthcare providers use the EHRA score to track symptom changes over time and assess treatment effectiveness
- The EHRA score is valuable for monitoring symptom progression and treatment response in atrial fibrillation management, allowing for more personalized care based on how symptoms affect the patient's quality of life.
The most recent guidelines from 2024 1 support the use of the EHRA score in clinical practice, highlighting its importance in assessing and managing atrial fibrillation symptoms.
From the Research
Definition of EHRA Score
- The European Heart Rhythm Association (EHRA) score is a classification system used to assess the symptoms of atrial fibrillation (AF) 2, 3, 4, 5.
- It is a semi-quantitative classification that evaluates the severity of AF symptoms and their impact on a patient's quality of life.
Classification System
- The EHRA score ranges from 1 to 4, with higher scores indicating more severe symptoms 2, 4.
- The classification system is as follows:
- Class 1: No symptoms
- Class 2: Mild symptoms (e.g., palpitations, dyspnea) that do not limit daily activities
- Class 3: Severe symptoms that limit daily activities
- Class 4: Disabling symptoms that severely limit daily activities
Validation and Improvement
- The EHRA score has been validated and improved through various studies, including the development of a modified EHRA (mEHRA) score 2.
- The mEHRA score separates Class 2 into two subcategories: 2a (symptomatic AF not limiting daily activities) and 2b (symptomatic AF that is troubling to the patient) 2.