CHA₂DS₂-VASc Score Calculation for a 66-Year-Old Male with Multiple Risk Factors
The correct CHA₂DS₂-VASc score for this 66-year-old male with diabetes mellitus, hypertension, smoking history, prior stroke, S3 heart sound, and distended JVP is 6 points.
Score Calculation Breakdown
According to the CHA₂DS₂-VASc scoring system outlined in the American College of Cardiology/American Heart Association guidelines 1, the patient's score is calculated as follows:
| Risk Factor | Points | Present in This Patient |
|---|---|---|
| Congestive heart failure | 1 | Yes (S3 and distended JVP indicate heart failure) |
| Hypertension | 1 | Yes |
| Age ≥75 years | 2 | No |
| Diabetes mellitus | 1 | Yes |
| Prior Stroke/TIA | 2 | Yes |
| Vascular disease | 1 | No (not explicitly mentioned) |
| Age 65-74 years | 1 | Yes (66 years old) |
| Sex category (female) | 1 | No (male patient) |
| TOTAL | 6 |
Clinical Significance of This Score
This CHA₂DS₂-VASc score of 6 places the patient in a high-risk category for thromboembolic events:
- A score of 6 corresponds to an adjusted annual stroke rate of approximately 9.8% per year without anticoagulation 1
- According to the 2014 AHA/ACC/HRS guidelines, this patient has a clear indication for oral anticoagulation therapy 1
- The patient falls into the "high risk" category (>10%/year risk of arterial thromboembolism) according to the American College of Chest Physicians guidelines 1
Important Clinical Considerations
- The presence of S3 heart sound and distended JVP are clinical indicators of congestive heart failure, which contributes 1 point to the score 1
- Prior stroke contributes 2 points as it's one of the strongest predictors of future stroke 1
- The patient's age of 66 years contributes 1 point (age 65-74 years category) 1
- While the patient is a smoker, smoking alone is not a specific scoring criterion in the CHA₂DS₂-VASc system, though it does increase overall cardiovascular risk
Common Pitfalls in CHA₂DS₂-VASc Scoring
- Failing to count heart failure signs: The S3 heart sound and distended JVP are clinical indicators of heart failure, which contributes 1 point 1
- Miscounting age points: Age 65-74 contributes 1 point, while age ≥75 would contribute 2 points 1
- Overlooking prior stroke: Prior stroke/TIA contributes 2 points, not 1 point 1
- Confusing vascular disease: Vascular disease refers specifically to prior myocardial infarction, peripheral artery disease, or aortic plaque, not to risk factors like smoking 1
This CHA₂DS₂-VASc score of 6 indicates that the patient has a very high risk of stroke and would strongly benefit from oral anticoagulation therapy to reduce this risk, with DOACs being preferred over warfarin in eligible patients 2.