What is CHADS2 and CHA2DS2-VASc Scoring?

One of the most concerning consequence of atrial fibrillation is the five-times-greater risk of developing a stroke compared to those without AF. This is because AFib can promote the pooling and subsequent clotting of blood in the heart. When that clot (thrombus) travels outside of the heart it is called a thromboembolism. If it goes to the brain it causes a stroke. One of the first lines of treatment for atrial fibrillation includes anticoagulants or blood thinners.

To better understand a patient’s risk of stroke, researchers developed the CHADS2 scoring system which rates patients on a scale of 1 to 6 points. Zero represents the lowest risk and 6 represents the highest. The criteria include:

  • •Congestive heart failure (1 point)
  • High blood pressure (1 point)
  • Age > 75 (1 point)
  • Diabetes (1 point)
  • Stroke (2 points)

The CHADS2 scoring system made it clear that even a score of zero represented some risk of a thromboembolic event if no anticoagulant was employed. Therefore, further risk stratification was added with CHA2DS2-VASc

  • Congestive heart failure (1 point)
  • High blood pressure (1 point)
  • Age 65-74 (1 point) or Age 75+ (2 points)
  • Diabetes (1 point)
  • Stroke (2 points)
  • Vascular disease (1 point)
  • Women (1 point)

This scoring system represents a useful tool to predict the risk of stroke in the average patient. Of course, as with any system that uses large sampling data, there will be exceptional circumstances and therefore results must be interpreted individually. However, annual stroke risk increases as the CHA2DS2-VASc score does. Patients with a score of 1 experience an approximately 1.3% risk of stroke annually while a CHA2DS2-VASc of 9 implies a stroke risk of over 15% annually.

Generally, a score of zero in men and one in women represents low risk, which suggests that anticoagulation therapy may not be necessary but still must be considered. A score of one in men and two in women is considered low to moderate risk and leaves the use of anticoagulants to discretion. A score of two or higher is considered moderate-to-high risk and these patients, unless otherwise indicated, should be on an anticoagulant regimen.

One of the most important innovations of this era is a mechanical stroke prevention device called the Watchman. With this on average 30 minute procedure, patients that are not good candidates for blood thinners finally can be protected from a stroke with no need to be exposed to the bleeding risks of these drugs.

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