Fast Five Quiz: Clinical Management of Atrial Fibrillation

Sandeep K. Goyal, MD


March 13, 2023

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.

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