How do I calculate a patient's CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or Transient Ischemic Attack, Vascular disease, Age 65-74 years, Sex category) score?

From the Guidelines

To calculate a patient's CHA2DS2-VASc score, assign points for each risk factor present and sum them up, using the scoring system outlined in the 2016 ESC guidelines for the management of atrial fibrillation 1. The scoring system allocates 1 point each for congestive heart failure, hypertension, diabetes mellitus, vascular disease (prior MI, peripheral artery disease, or aortic plaque), age 65-74 years, and female sex. Age ≥75 years and previous stroke/TIA/thromboembolism each receive 2 points. For heart failure, include both reduced and preserved ejection fraction. For hypertension, include patients currently on medication even if their blood pressure is controlled. The total score ranges from 0-9 and helps determine stroke risk in atrial fibrillation patients, guiding anticoagulation decisions, as recommended by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1. Some key points to consider when calculating the score include:

• Congestive heart failure: +1 point
• Hypertension: +1 point
• Age 75 years or older: +2 points
• Diabetes mellitus: +1 point
• Previous stroke, transient ischaemic attack, or thromboembolism: +2 points
• Vascular disease: +1 point
• Age 65–74 years: +1 point
• Sex category (female): +1 point Generally, males with a score ≥2 or females with a score ≥3 are recommended for oral anticoagulation therapy, as stated in the 2014 AHA/ACC/HRS guideline 1. This scoring system is valuable because it identifies patients who would benefit most from anticoagulation while avoiding unnecessary treatment in truly low-risk individuals. It is also supported by the 2016 ESC guidelines, which provide a comprehensive approach to the management of atrial fibrillation, including the use of the CHA2DS2-VASc score to assess stroke risk 1.

From the Research

Calculating CHA2DS2-VASc Score

To calculate a patient's CHA2DS2-VASc score, the following criteria are used:

• Congestive Heart Failure (1 point)
• Hypertension (1 point)
• Age ≥ 75 years (2 points)
• Diabetes (1 point)
• Stroke or Transient Ischemic Attack (2 points)
• Vascular disease (1 point)
• Age 65-74 years (1 point)
• Sex category (female) (1 point)

Step-by-Step Calculation

1. Evaluate the patient's medical history for the presence of each criterion.
2. Assign the corresponding points for each criterion that is present.
3. Sum the points to obtain the total CHA2DS2-VASc score.

Interpretation of CHA2DS2-VASc Score

The CHA2DS2-VASc score is used to stratify the risk of stroke in patients with atrial fibrillation 2, 3, 4. A higher score indicates a greater risk of stroke. The score can be used to guide decisions regarding anticoagulation therapy.

Key Findings

• The CHA2DS2-VASc score is a useful predictive tool for identifying patients with heart failure who are at high risk of stroke and mortality 4.
• Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation, and may be considered separately when assessing stroke risk 5.
• The score has been validated in various populations, including patients with atrial fibrillation and heart failure 2, 3, 4.

Calculation Example

For example, a 72-year-old female patient with hypertension, diabetes, and a history of stroke would have a CHA2DS2-VASc score of:

• Congestive Heart Failure: 0 points
• Hypertension: 1 point
• Age ≥ 75 years: 0 points
• Diabetes: 1 point
• Stroke or Transient Ischemic Attack: 2 points
• Vascular disease: 0 points
• Age 65-74 years: 1 point
• Sex category (female): 1 point Total score: 6 points

This patient would be considered at high risk of stroke and would likely require anticoagulation therapy 2, 3.