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CHADS score (CHADS2 score; CHA2DS2-VASc score)

Indications: - clinical prediction rule for estimating the risk of stroke in patients with nonrheumatic, or nonvalvular, atrial fibrillation - in patients with heart failure, predictive accuracy is modest, & clinical utility unknown [7] Procedure: The CHADS2 scoring table is shown below: - Condition Points CHA2DS2-VASc score [5] C Congestive heart failure 1 1 H Hypertension (or treated hypertension) 1 1 A Age >75 years 1 2 D Diabetes 1 1 S2 Prior Stroke or TIA 2 2 V vascular disease N/A 1 A Age 65-74 N/A 1 S Female sex N/A 1 - Adding together the points results in the CHADS2 score. - This score is used to estimate stroke risk. * not all factors worth 1 point in the CHADS2 score score convey equal risk. For example, age between 65-74 is associated with higher risk than other factors [6] - CHADS2* Score & Annual Stroke Risk in patients with atrial fibrillation CHADS2* Score Stroke Risk % 95% CI 0 1.9 1.2-3.0 1 2.8 2.0-3.8 2 4.0 3.1-5.1 3 5.9 4.6-7.3 4 8.5 6.3-11.1 5 12.5 8.2-17.5 6 18.2 10.5-27.4 - See Management: for recommendations for anticoagulation Management: Recommendations for anticoagulation [2,4] CHADS2* Score Risk Anticoagulation 0 Low aspirin# 1 Moderate aspirin# or anticoagulation* >= 2 Moderate-High anticoagulation* (men) >= 3 high anticoagulation* (women) * CHA2DS2-VASc score with same risk & recommendations as CHADS2 score [5,8] aspirin 325 mg/day, lower doses may be as effective anticoagulation* with direct oral anticoagulation or warfarin to achieve INR of 2.0-3.0, unless contraindicated (i.e., history of falls, clinically significant bleeding, non-compliance, inability to obtain regular INR) * only warfarin is indicated for valvular atrial fibrillation # aspirin alone no longer used for prevention of embolic stroke in patients with atrial fibrillation [4] ref [4] suggests anticoagulation unless CHADS2 score = 0 ref [4] suggests anticoagulation in patients with hypertrophic cardiomyopathy regardless of CHA2DS2-VASc score - ref [11] has a different take on silent atrial fibrillation - CHA2DS2-VASc score > 4, apixaban resulted in 1.3 fewer episodes of stroke or systemic embolism per 100 patient-years without significant increase in bleeding - CHA2DS2-VASc score of <= 4 or less, reduction in stroke or systemic embolism withh apixaban not statistically significant

Related

atrial fibrillation (AF)

General

risk calculator numerical rating scale (NRS)

References

  1. Wikipedia: CHADS score http://en.wikipedia.org/wiki/CHADS_Score
  2. Gage BF et al Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin Circulation 2004, 110:2287-92 PMID: 15477396 http://circ.ahajournals.org/cgi/content/full/110/16/2287
  3. Gage BF et al Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation JAMA 2001, 285:2864-70 PMID: 11401607 http://jama.ama-assn.org/cgi/content/full/285/22/2864
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. Olesen JB et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: Nationwide cohort study. BMJ 2011 Jan 31; 342:d124 PMID: 21282258
  6. Friberg L et al. Benefit of anticoagulation unlikely in patients with atrial fibrillation and CHA2DS2-VASc score of 1. J Am Coll Cardiol 2015 Jan 27; 65:225 PMID: 25614418 - Singer DE and Ezekowitz MD. Adding rigor to stroke risk prediction in atrial fibrillation. J Am Coll Cardiol 2015 Jan 27; 65:233. PMID: 25614419 - Chao T-F et al. Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J Am Coll Cardiol 2015 Feb 24; 65:635. PMID: 25677422 - Lip GY et al. Oral anticoagulation, aspirin, or no therapy in patients with nonvalvular AF with 0 or 1 stroke risk factor based on the CHA2DS2-VASc score. J Am Coll Cardiol 2015 Apr 14; 65:1385. PMID: 25770314
  7. Melgaard L, Gorst-Rasmussen A, Lane DA et al Assessment of the CHA2DS2-VASc Score in Predicting Ischemic Stroke, Thromboembolism, and Death in Patients With Heart Failure With and Without Atrial Fibrillation. JAMA. Published online August 30, 2015. PMID: 26318604 http://jama.jamanetwork.com/article.aspx?articleid=2431702
  8. Hsu JC, Maddox TM, Kennedy K et al Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke. J Am Coll Cardiol. 2016;67(25):2913-2923 PMID: 27339487 http://content.onlinejacc.org/article.aspx?articleID=2529509 - Deshpande S, Wann LS Aspirin in Atrial Fibrillation. The Clot Thickens. J Am Coll Cardiol. 2016;67(25):2924-2926. PMID: 27339488 http://content.onlinejacc.org/article.aspx?articleID=2529510
  9. Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE. Effect of variation in published stroke rates on the net clinical benefit of anticoagulation for atrial fibrillation. Ann Intern Med. 2018 Oct 16;169(8):517-527. Epub 2018 Sep 25. PMID: 30264130 http://annals.org/aim/article-abstract/2703439/effect-variation-published-stroke-rates-net-clinical-benefit-anticoagulation-atrial? - Wright JM, January CT. Atrial fibrillation and anticoagulation: One size fits all? Ann Intern Med. 2018 Oct 16;169(8):575-576 PMID: 30264144 http://annals.org/aim/article-abstract/2703442/atrial-fibrillation-anticoagulation-one-size-fits-all?
  10. Chao TF, Chiang CE, Chen TJ et al Reassessment of Risk for Stroke During Follow-up of Patients With Atrial Fibrillation. Ann Intern Med. 2019. Jan 1. PMID: 30597483 http://annals.org/aim/article-abstract/2720037/reassessment-risk-stroke-during-follow-up-patients-atrial-fibrillation
  11. Lopes RD et al. Apixaban versus aspirin according to CHA2DS2-VASc score in subclinical atrial fibrillation: Insights from ARTESiA. J Am Coll Cardiol 2024 May 19; [e-pub]. PMID: 39019530 https://www.sciencedirect.com/science/article/abs/pii/S0735109724071602
  12. Calculators: - CHADS2 Score https://www.qxmd.com/calculate/calculator_40/chads2-score-for-af - CHA2DS2-VASc Score http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/