What Is a CHA2DS2-VASc Score?

December 18, 2023

Doctor listening to woman patient's heart using stethoscopeStroke risk in Afib patients is evaluated in part with the CHA2DS2-VASc Score. As you have likely read elsewhere on this website, Atrial Fibrillation or Afib is a significant concern in the US population, with an estimated five million people suffering from its effects. While Afib itself can be at best annoying and at worst debilitating, the true risk of Afib is the five times increased chance of stroke if left untreated. While we have many treatment options, we must 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 increase the risk of stroke. More recently, a new and updated version known as CHA2DS2-VASc has become our most accurate risk stratification tool, offering more precise results for low-risk patients than its predecessor.

This scoring system is used to develop risk status for patients and inform a treatment plan for Afib. It 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 up to 10, you have a maximum of two points for your age.

What Do These Scores Mean?

On the surface, a CHA2DS2-VASc score on the lower end of the scale means 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 in females, with a score of 1. From there, medium risk in males is a score of one. Males and females with a score of two or higher are given a high-risk designation.

Your cardiologist will work closely with Dr. Banker 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 an RF catheter ablation or cardiac cryoablation may be considered. Of course, treatment is determined in consultation with Dr. Banker.

Make an appointment with Dr. Banker if you are experiencing Afib and/or fall in the moderate to high-risk CHA2DS2-VASc category. Of course, if you believe you have a medical emergency, dial 911 or go to the ER immediately.