CHA₂DS₂-VASc Score

Understanding and Using the CHA₂DS₂-VASc Score in Cardiology

Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major risk factor for ischemic stroke. The CHA₂DS₂-VASc score was developed to refine the assessment of thromboembolic risk in patients with non-valvular AF, replacing the older CHADS₂ score.

What is the CHA₂DS₂-VASc Score?

The acronym CHA₂DS₂-VASc groups major and minor clinical risk factors. The maximum possible score is 9 points:

• C (Congestive Heart Failure): Heart failure or left ventricular dysfunction (LVEF ≤ 40%).
• H (Hypertension): Arterial hypertension (treated or untreated).
• A₂ (Age ≥ 75): Advanced age is a major risk factor (+2 points).
• D (Diabetes): Diabetes mellitus (type 1 or 2).
• S₂ (Stroke): Prior stroke, TIA, or systemic thromboembolism (+2 points).
• V (Vascular Disease): Vascular disease (prior myocardial infarction, peripheral artery disease, complex aortic plaque).
• A (Age 65-74): Intermediate age (+1 point).
• Sc (Sex Category): Female sex is a risk-modifying factor (+1 point).

Interpretation and Therapeutic Decision (ESC Guidelines)

Initiation of anticoagulant therapy (Direct Oral Anticoagulants - DOACs or VKAs) depends on sex and total score. DOACs are now preferred as first-line over VKAs due to their better safety profile (fewer intracranial hemorrhages).

References:

1. Lip GY, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest. 2010. [Chest Journal]
2. Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021. [ESC - Eur Heart J]