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What Is a CHA2DS2-VASc Score?

Stroke risk evaluation in Afib patients evaluated by CHA2DS2-VASc Score at The Heart House in New Jersey

As you have likely read elsewhere on this website, Atrial Fibrillation or Afib is a significant concern in the US population, with an estimated 5 million+ people suffering from its effects. While a Afib itself is can be (at best) annoying and at worst debilitating, the true risk is the five times increased chance of stroke that comes along with it. While we have a multitude of treatment options, it is important that we stratify that risk, as not all patients are the same and some may require earlier intervention than others. As a result of this need, the CHADS2 score was created. It is a scoring methodology based on several factors that would increase the risk of stroke. More recently, a new and updated version known as CHA2DS2-VASc has taken over as the most accurate risk stratification tool, offering more accurate results for low-risk patients than its predecessor.

This scoring system is used, in part, to develop a treatment plan for a Afib and includes the following risk factors

  • C for Congestive heart failure adds 1 point.
  • H for Hypertension or high blood pressure adds 1 point
  • A for Age greater than or equal to 75 years adds 2 points
  • D for Diabetes mellitus or type 2 diabetes adds 1 point 
  • S for prior Stroke or TIA adds 2 points 
  • V for Vascular disease adds 1 point 
  • A for Age between 65 and 74 years adds 1 point 
  • S for female Sex adds 1 point

The maximum score for a CHA2DS2-VASc is nine. Note that while the points above add to 10, you can only have a maximum of two points for your age.

What Do These Scores Mean?

On the surface, it may seem that a CHA2DS2-VASc score on the lower end of the scale means that no treatment is necessary. However, if you scrutinize the risk categories, they are all significant and add substantial risk of stroke. Therefore, anticoagulant treatment is likely unnecessary only in males with a score of 0 and females with a score of 1. From there, medium risk is when a male patient reaches a score of one and males and females with a score of two or higher are given a high risk designation.

Your cardiologist will work closely with your electrophysiologist to determine the best course of action. Anticoagulants are appropriate and effective in about 50% of patients. However, in the other 50% who don’t receive a benefit or have too many side effects, a curative procedure such as a RF catheter ablation or cardiac cryoablation may be considered. Of course, treatment is determined in consultation with a qualified physician, such as those at The Heart House. 

Please make an appointment with one of our cardiologists as soon as possible if you happen to fall in the moderate to high-risk CHA2DS2-VASc category or if you are experiencing any unusual cardiovascular related issues. If you believe you are having a medical emergency, dial 911 or go to the ER immediately.

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