Fast Five Quiz: Clinical Management of Atrial Fibrillation

Sandeep K. Goyal, MD


April 02, 2020

Both the AHA/ACC/HRS and ESC use the CHA2DS2-VASc (congestive heart failure, hypertension, aged ≥ 75 years [two scores], diabetes mellitus, stroke or transient ischemic attack [TIA] [doubled], vascular disease, aged 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 recently replaced the less comprehensive CHADS2 (cardiac failure, hypertension, aged > 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

  • Aged ≥ 75 years: 2 points

  • Diabetes: 1 point

  • Stroke, TIA, or thromboembolism history: 2 points

  • Vascular disease (eg, MI, peripheral arterial disease, aortic plaque): 1 point

  • Aged 65-74 years: 1 point

  • Sex category (female sex): 1 point

In general, US guidelines suggest men who have a CHA2DS2-VASc score ≥ 2 and women who have a score ≥ 3 require long-term anticoagulation therapy, whereas the ESC guidelines recommend initiating DOAC agents in men with a CHA2DS2-VASc score ≥ 1 and in women with a score ≥ 2.

The change in scoring systems ensures that more than 98% of patients diagnosed with AF require long-term anticoagulation therapy. This measure increases the number of patients receiving anticoagulation therapy in the United States by 1 million. 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 a deep vein thrombosis but not yearly thromboembolic risk.

The Framingham risk score estimates a patient's 10-year risk of MI.

The PSI/PORT score assesses severity of pneumonia and risk of death.

Learn more about the CHA2DS2-VASc score.


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