What goes into the CHA₂DS₂-VASc
- Heart failure or LV dysfunction (+1)
- Hypertension (+1)
- Age: < 65 (0); 65-74 (1); ≥ 75 (2)
- Diabetes (+1)
- Prior stroke, TIA or thromboembolism (+2)
- Vascular disease (MI, PAD, aortic plaque) (+1)
- Sex: Male (0); Female (1)
How to interpret the result
- 0 (men) or 1 (women): low risk; anticoagulation not recommended
- 1 (men) or 2 (women): anticoagulation is reasonable after shared decision-making
- ≥ 2 (men) or ≥ 3 (women): anticoagulation recommended unless contraindicated; DOAC preferred over warfarin for most
Clinical pearls
- Female sex is a risk modifier: it raises risk only when another factor is present.
- Does not apply to AF with a mechanical valve or moderate-severe mitral stenosis, which need anticoagulation regardless.
- The anticoagulation decision is independent of choosing rate or rhythm control.
Evidence
- Lip GYH, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest. 2010;137:263-272.
- Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149:e1-e156.
Related workups
Related calculators
For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.