CHA₂DS₂-VASc Score Calculator
Calculates stroke risk in patients with atrial fibrillation to guide anticoagulation therapy decisions. Recommended by ACC/AHA/ESC guidelines.
Patient Risk Factors
History of CHF or objective evidence of LV dysfunction
Resting BP >140/90 mmHg on 2+ occasions or current antihypertensive treatment
Age ≥75 scores 2 points; Age 65-74 scores 1 point
Fasting glucose ≥126 mg/dL or treatment with oral hypoglycemic/insulin
History of stroke, TIA, or systemic thromboembolism (2 points)
Prior MI, peripheral artery disease, or aortic plaque
Female sex adds 1 point (only if other risk factors present)
CHA₂DS₂-VASc Components
CHA₂DS₂-VASc Score
Enter values to calculate
About This Calculator
The CHA₂DS₂-VASc score is a clinical prediction rule used to estimate the risk of stroke in patients with non-rheumatic atrial fibrillation (AF). It is an improvement over the older CHADS₂ score and is recommended by major cardiology guidelines including ACC/AHA and ESC.
The acronym represents the risk factors assessed: • C - Congestive heart failure/LV dysfunction (1 point) • H - Hypertension (1 point) • A₂ - Age ≥75 years (2 points) • D - Diabetes mellitus (1 point) • S₂ - Stroke/TIA/thromboembolism history (2 points) • V - Vascular disease (MI, PAD, aortic plaque) (1 point) • A - Age 65-74 years (1 point) • Sc - Sex category (female) (1 point)
The maximum score is 9 points. Higher scores indicate greater annual stroke risk and stronger indication for anticoagulation therapy.
Note: The 2024 ESC guidelines introduced CHA₂DS₂-VA (removing sex category), but CHA₂DS₂-VASc remains widely used and validated.
Formula
CHA₂DS₂-VASc = C + H + A₂ + D + S₂ + V + A + Sc (maximum 9 points)Each criterion adds points as follows: • **C**ongestive heart failure/LV dysfunction: +1 point • **H**ypertension: +1 point • **A**ge ≥75 years: +2 points • **D**iabetes mellitus: +1 point • **S**troke/TIA/thromboembolism: +2 points • **V**ascular disease (MI, PAD, aortic plaque): +1 point • **A**ge 65-74 years: +1 point • **S**ex category (female): +1 point Note: Age points are mutually exclusive (either 0, 1, or 2 points based on age category). Female sex only contributes if other risk factors are present (female sex alone = 0 points for treatment decisions).
Clinical Considerations
- •This score is validated for non-valvular atrial fibrillation only
- •Not applicable to patients with mechanical heart valves or moderate-severe mitral stenosis
- •Female sex alone (score of 1 in women) does not warrant anticoagulation
- •Clinical judgment should guide therapy; score is one factor in decision-making
- •Bleeding risk (HAS-BLED score) should also be assessed
- •DOACs are contraindicated in severe renal impairment (varies by agent)
Limitations
- •Modest predictive accuracy for individual patient stroke risk
- •Does not account for all stroke risk factors (e.g., obesity, sleep apnea)
- •Developed primarily in European populations
- •Does not incorporate AF burden or type (paroxysmal vs persistent)
- •Bleeding risk assessment (HAS-BLED) should be done separately
Interpretation Guide
| Range | Classification | Recommendation |
|---|---|---|
| <-1 | Low Risk | Low stroke risk. For men with score 0 or women with score 1 (sex only): anticoagulation generally not recommended. Consider aspirin or no antithrombotic therapy. |
| 1-2 | Low-Moderate Risk | Low-moderate risk. Oral anticoagulation should be considered. Discuss risks and benefits with patient. Shared decision-making recommended. |
| 2-4 | Moderate Risk | Moderate stroke risk. Oral anticoagulation recommended (DOAC preferred over warfarin in most patients) unless contraindicated. |
| 4-6 | High Risk | High stroke risk. Oral anticoagulation strongly recommended. DOACs preferred unless contraindicated (mechanical valve, moderate-severe mitral stenosis). |
| 6-10 | Very High Risk | Very high stroke risk. Oral anticoagulation essential. Ensure compliance and regular follow-up. Consider left atrial appendage occlusion if anticoagulation contraindicated. |
Frequently Asked Questions
What is the CHA₂DS₂-VASc score?
CHA₂DS₂-VASc is a clinical prediction tool that estimates the annual risk of stroke in patients with atrial fibrillation. It helps clinicians decide whether anticoagulation therapy is appropriate to prevent stroke.
What score requires anticoagulation?
According to ACC/AHA guidelines, oral anticoagulation is recommended for men with a score ≥2 and women with a score ≥3. For men with a score of 1 and women with a score of 2, anticoagulation should be considered based on individual risk-benefit assessment.
Why does female sex add a point?
Female sex is associated with increased stroke risk in AF, particularly in older women and those with other risk factors. However, female sex alone (without other risk factors) does not warrant anticoagulation. This is why a woman with only the sex category point (score of 1) is treated the same as a man with score 0.
Should I use CHADS₂ or CHA₂DS₂-VASc?
CHA₂DS₂-VASc is preferred over the older CHADS₂ score. It better identifies truly low-risk patients (who may not need anticoagulation) while also capturing more risk factors. Current guidelines recommend CHA₂DS₂-VASc.
What is the difference between CHA₂DS₂-VASc and CHA₂DS₂-VA?
The 2024 ESC guidelines introduced CHA₂DS₂-VA, which removes the sex category. This simplification was made because female sex appears to be an age-dependent risk modifier rather than an independent risk factor. However, CHA₂DS₂-VASc remains widely validated and used.
References
1. Lip GY, Nieuwlaat R, Pisters R, et al.. Guidelines for the management of atrial fibrillation. European Heart Journal. 2010. doi: 10.1093/eurheartj/ehq278
View Source →2. January CT, Wann LS, Alpert JS, et al.. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2014. doi: 10.1161/CIR.0000000000000041
View Source →3. Hindricks G, Potpara T, Dagres N, et al.. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal. 2021. doi: 10.1093/eurheartj/ehaa612
View Source →4. Lip GY, Frison L, Halperin JL, Lane DA. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation. Chest. 2010. doi: 10.1378/chest.09-1584
View Source →Last updated: 2025-01-15
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