CHA₂DS₂-VASc Score Calculation for the 66-year-old Male Patient
The CHA₂DS₂-VASc score for this 66-year-old male patient with diabetes mellitus, hypertension, smoking history, prior stroke, and signs of heart failure (S3, distended JVP) is 5 points.
Detailed Score Calculation
Let's calculate the CHA₂DS₂-VASc score systematically by assessing each component:
| Risk Factor | Present? | Points |
|---|---|---|
| Congestive heart failure | Yes (S3, distended JVP) | 1 |
| Hypertension | Yes | 1 |
| Age ≥75 years | No | 0 |
| Diabetes mellitus | Yes | 1 |
| Prior Stroke/TIA | Yes | 2 |
| Vascular disease | No (smoking is not included) | 0 |
| Age 65-74 years | Yes (66 years old) | 1 |
| Sex category (female) | No (male patient) | 0 |
| TOTAL | 5 |
Explanation of Scoring
Congestive heart failure (1 point): The patient has clinical signs of heart failure, including an S3 heart sound and distended jugular venous pressure (JVP) 1.
Hypertension (1 point): The patient has a history of hypertension (HTN) 1.
Age ≥75 years (0 points): The patient is 66 years old, which is below the 75-year threshold for this doubled risk factor 1.
Diabetes mellitus (1 point): The patient has diabetes mellitus (DM) 1.
Prior Stroke/TIA (2 points): The patient has a history of stroke, which is a doubled risk factor worth 2 points 1.
Vascular disease (0 points): While the patient is a smoker, smoking alone is not included in the definition of vascular disease for the CHA₂DS₂-VASc score. Vascular disease refers specifically to prior myocardial infarction, peripheral arterial disease, or aortic plaque 1, 2.
Age 65-74 years (1 point): The patient is 66 years old, which falls within this age category 1.
Sex category (0 points): The patient is male, so no points are assigned for this category 1.
Clinical Implications
With a CHA₂DS₂-VASc score of 5, this patient has a high risk of stroke, approximately 4.31% per year without anticoagulation 1. This score indicates that oral anticoagulation therapy is strongly recommended to reduce stroke risk 2.
Common Pitfalls to Avoid
Not counting heart failure signs correctly: The presence of S3 and distended JVP are clinical signs of heart failure, warranting 1 point even without a formal heart failure diagnosis.
Confusing smoking with vascular disease: Smoking is a risk factor for vascular disease but is not itself counted as vascular disease in the CHA₂DS₂-VASc score. Vascular disease specifically refers to prior myocardial infarction, peripheral arterial disease, or aortic plaque.
Double-counting age: Ensure that points for age are assigned to only one category (either 65-74 years or ≥75 years), not both.
Forgetting to double the points for stroke: Prior stroke/TIA carries 2 points, not 1, as it's a particularly strong risk factor for recurrent stroke.