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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjE3MjU5Ny1vdmVydmlldw==\nDrugs & Diseases > Protocols\nCHADS2 Score for Stroke Risk Assessment in Atrial Fibrillation\nAuthor: Tarek Ajam, MD, MS; more...\nSections CHADS2 Score for Stroke Risk Assessment in Atrial Fibrillation\nCHADS2 and CHA2DS2-VASc Score for Stroke Risk Assessment in Atrial Fibrillation\nAtrial fibrillation (AF) is a cardiac arrhythmia with the potential to cause thromboembolism. Studies suggest that AF increases the risk of stroke five-fold. [1] Thus, it is important to determine which patients with AF may benefit from oral anticoagulant (OAC) and possibly aspirin therapy to reduce the risk of stroke. OACs used in this setting include the following medications for stroke preventions in atiral fibrillation:\nWarfarin, with a goal International Normalized Ratio (INR) of 2-3 and percent time in therapeutic INR (TTR) remains ≥ 70%\nFirst published in 2001, the CHADS2 score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke [double weight]) was developed to more accurately predict the risk of stroke in patients with nonrheumatic AF. [2] The index was derived by combining risk factors from prior studies and then testing their validity in a cohort of 1,773 Medicare-aged patients over 2,121 patient years. [3, 4] Valvular AF which is not represented by this study includes the presence of moderate to severe mitral stenosis or the presence of mechanical prosthetic valve.\nSee Tables 1 and 2, below.\nTable 1. CHADS2 Score: Stroke Risk Assessment in Atrial Fibrillation (Open Table in a new window)\nCHADS2 Risk Criteria\nAge ≥ 75 years\nStroke/transient ischemic attack\nTable 2. CHADS2 Score and Corresponding Annual Stroke Risk (Open Table in a new window)\nCHADS2 Score\nAdjusted Stroke Risk (%)\nThe above adjusted stroke rates are based on data for hospitalized patients with AF and were published in 2001. [2] Actual stroke rates in contemporary nonhospitalized cohorts might vary from these estimates since stroke rates are decreasing [5]\nSee also Medscape's Atrial Fibrillation CHADS2 Score for Stroke Risk calculator.\nAlthough simple, the CHADS2 score does not include many common stroke risk factors, and its limitations have been highlighted by its non-inclusion of common stroke risk factors. Even patients classified as low risk by CHADS2 in its original validation study have a stroke rate of 1.9% per year, which is close to the criterion of a cardiovascular event rate of 20% over 10 years for primary prevention strategies (ie, statin therapy). [6, 7]\nConsequently, CHADS2 was expanded to include three additional independent risk factors: vascular disease (coronary artery disease, peripheral artery disease, aortic atherosclerosis), age 65-74 years, and female sex. [8, 9, 10] This new, more inclusive scoring system is the CHA2DS2-VASc score. [11]\nThe CHA2DS2-VASc score better discriminated stroke risk in nonvalvular AF subjects with a baseline CHADS2 score of 0 to 1; its improved predictive ability was demonstrated in a nationwide Danish registry from 1997 to 2008. [12] In a Swedish population with nonvalvular AF, [13] women had a moderately increased stroke risk compared with men. However, women younger than 65 years without other AF risk factors had a low risk for stroke, and it was concluded that those patients did not require OAC prophylaxis.\nThe 2016 European Society of Cardiology (ESC) guidelines recommend using the CHA2DS2-VASc score to estimate stroke risk in AF patients and to start OACs in men with a score of 1 or higher and women with a score of 2 or higher. [14] The 2014 American Heart Association/ American College of Cardiology/ Heart Rhythm Society (AHA/ACC/HRS) guidelines also recommend the CHA2DS2-VASc score for the assessment of stroke risk in paitents with nonvalvular AF. Consideration of OAC prophylaxis is recommended for patients with a score of 1 and OAC use is a definite recommendation for patients with a score of 2 or greater and for those with a history of stroke or transient ischemic attack. [15]\nUse of the CHA2DS2-VASc score to determine stroke risk in patients having cardiac surgery independent of AF has been advocated. [18] Stroke prevention versus bleeding risk in AF can be addressed if the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly) score is also calculated with the CHA2DS2-VASc score.\nSee Tables 3, 4, and 5, below. See also Medscape's Atrial Fibrillation CHA2DS2-VASc Score for Stroke Risk calculator.\nTable 3. CHA2DS2-VASc Score and Risk Criteria (Open Table in a new window)\nCHA2DS2-VASc Risk Criteria\nAge ≥75 years\nStroke/Transient Ischemic Attack/Thromboembolic event\nVascular disease (prior MI, PAD, or aortic plaque)\nAge 65 to 74 years\nSex category (ie, female sex)\nTable 4. CHA2DS2-VASc Score and Corresponding Annual Stroke Risk (Open Table in a new window)\nCHA2DS2-VASc Score\nAdjusted Stroke Risk, (% per year)\nAdjusted stroke rate scores are based on data from Lip and colleagues. [5, 8, 16, 17] The actual rates of stroke in contemporary cohorts may vary from these estimates.\nTable 5. Treatment Recommendations Based on CHA2DS2-VASc Score [15] (Open Table in a new window)\nNone or aspirin or OAC\nWhich oral anticoagulants (OAC) are used for stroke prevention in atrial fibrillation (AF)?\nWhat is the CHADS2 score?\nWhat is the CHA2DS2-VASc score?\nWolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991 Aug. 22 (8):983-8. [Medline].\nGage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001 Jun 13. 285(22):2864-70. [Medline].\nAtrial Fibrillation investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994 Jul 11. 154(13):1449-57. [Medline].\nStroke Prevention Atrial Fibrillation III Writing Committee. Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: Stroke Prevention in Atrial Fibrillation III Study. The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. JAMA. 1998 Apr 22-29. 279(16):1273-7. [Medline].\nLip GY, Tse HF, Lane DA. Atrial fibrillation. Lancet. 2012 Feb 18. 379 (9816):648-61. [Medline].\nYou JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, et al. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb. 141 (2 Suppl):e531S-75S. [Medline].\n[Guideline] Fuster V, Rydén LE, Cannom DS et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006 Aug 15. 114 (7):e257-354. [Medline].\nOlesen JB, Lip GY, Lane DA, Køber L, Hansen ML, Karasoy D, et al. Vascular disease and stroke risk in atrial fibrillation: a nationwide cohort study. Am J Med. 2012 Aug. 125 (8):826.e13-23. [Medline].\nFriberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012 Jun. 33 (12):1500-10. [Medline].\nvan Walraven C, Hart RG, Connolly S, Austin PC, Mant J, Hobbs FD, et al. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators. Stroke. 2009 Apr. 40 (4):1410-6. [Medline].\n[Guideline] Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012 Nov. 33 (21):2719-47. [Medline].\nOlesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study. Thromb Haemost. 2012 Jun. 107 (6):1172-9. [Medline].\nFriberg L, Benson L, Rosenqvist M, Lip GY. Assessment of female sex as a risk factor in atrial fibrillation in Sweden: nationwide retrospective cohort study. BMJ. 2012 May 30. 344:e3522. [Medline].\n[Guideline] Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016 Nov. 18 (11):1609-1678. [Medline].\n[Guideline] January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2. 130 (23):e199-267. [Medline]. [Full Text].\nLip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb. 137 (2):263-72. [Medline].\nLane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012 Aug 14. 126 (7):860-5. [Medline].\nPeguero JG, Issa O, Podesta C, Elmahdy HM, Santana O, Lamas GA. Usefulness of the CHA2DS2VASc score to predict postoperative stroke in patients having cardiac surgery independent of atrial fibrillation. Am J Cardiol. 2015 Mar 15. 115 (6):758-62. [Medline].\nTable 1. CHADS2 Score: Stroke Risk Assessment in Atrial Fibrillation\nTable 2. CHADS2 Score and Corresponding Annual Stroke Risk\nTable 3. CHA2DS2-VASc Score and Risk Criteria\nTable 4. CHA2DS2-VASc Score and Corresponding Annual Stroke Risk\nTable 5. Treatment Recommendations Based on CHA2DS2-VASc Score [15]\nTable 1. CHADS 2 Score: Stroke Risk Assessment in Atrial Fibrillation\nTable 2. CHADS 2 Score and Corresponding Annual Stroke Risk\nTable 3. CHA 2DS 2-VASc Score and Risk Criteria\nTable 4. CHA 2DS 2-VASc Score and Corresponding Annual Stroke Risk\nTable 5. Treatment Recommendations Based on CHA 2DS 2-VASc Score [15]\nTarek Ajam, MD, MS Fellow in Cardiovascular Medicine, Aurora Health Care\nTarek Ajam, MD, MS is a member of the following medical societies: American College of Cardiology, American College of Physicians, Syrian American Medical Society\nAli A Mehdirad, MD, FACC Harlene and Marvin Wool Endowed Professor of Cardiology, Professor of Medicine, Director, Electrophysiology Service, St Louis University School of Medicine\nAli A Mehdirad, MD, FACC is a member of the following medical societies: American College of Cardiology\nEthan Levine, DO Director of Cardiac Electrophysiology, Arnot Ogden Medical Center\nEthan Levine, DO is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society\nencoded search term (CHADS2 Score for Stroke Risk Assessment in Atrial Fibrillation) and CHADS2 Score for Stroke Risk Assessment in Atrial Fibrillation\nInternational Normalized Ratio (INR) Targets: Atrial Fibrillation and Flutter\nHoliday Heart Syndrome\nStroke Anticoagulation and Prophylaxis\nAtrial Fibrillation and Arterial Thromboembolism Risk\nAtrial Fibrillation Five Year Risk of Stroke\nVascular Risk Factors Promote Conversion to Alzheimer's\nThe Silver Tsunami Quiz: CVD in the Elderly\nDocs Still in Dark on Anticoagulant Choice in Severe Kidney Disease\nThe Top Trending Clinical Topics of 2018\nAccording to Cardiologists\nHow Much Physical Activity Offsets the Bad From Prolonged Sitting?\nICH Risk Increased With Low-Dose Aspirin in Primary Prevention\nPhilip Morris v Uruguay: A Story That Deserves Retelling\nVirginia Cardiologist Murdered While on Vacation in Belize\nGlucosamine Supplements Linked to Lower CVD Event Risks\nDiseases & Conditions Atrial Fibrillation\n2002 2172597-overview Tables & Protocols\nTables & Protocols CHADS2 Score for Stroke Risk Assessment in Atrial Fibrillation\nNews Flip of the Coin for New-Onset AFib With TAVR or SAVR\n2001 /viewarticle/913386 Article\nArticle AF Management: Are Clinicians in Agreement?"