The ESC uses the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years [two scores], diabetes, stroke or transient ischemic attack [TIA] [doubled], vascular disease, age 65-74 years, sex category) score to determine the patient's yearly thromboembolic risk, which then leads to selection of the appropriate anticoagulation regimen.
The CHA2DS2-VASc score has replaced the less comprehensive CHADS2 (cardiac failure, hypertension, age > 75 years, diabetes, prior stroke or TIA) score and provides a more accurate risk assessment.
A patient's CHA2DS2-VASc score is determined by assigning the following points:
Congestive heart failure: 1 point
Hypertension: 1 point
Age ≥ 75 years: 2 points
Diabetes: 1 point
Stroke, TIA, or thromboembolism history: 2 points
Vascular disease (eg, myocardial infarction, peripheral arterial disease, aortic plaque): 1 point
Age 65-74 years: 1 point
Sex category (female sex): 1 point
ESC guidelines recommend initiating DOAC agents in men with a CHA2DS2-VASc score ≥ 1 and in women with a score ≥ 2.
Although the ESC guidelines differ slightly from those in the United States, there is an assumed increase in patients receiving anticoagulation therapy in Europe as well. Concerns about increased bleeding risk in this large population of patients accompanies these changes.
The Wells criteria assess the probability of a patient developing deep vein thrombosis but not yearly thromboembolic risk.
The Framingham risk score estimates a patient's 10-year risk for MI.
The PSI/PORT score assesses severity of pneumonia and risk for death.
Learn more about stroke risk assessment in AF.
Medscape © 2023 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Sandeep K. Goyal. Fast Five Quiz: Clinical Management of Atrial Fibrillation - Medscape - Mar 13, 2023.