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CHA₂DS₂-VASc / CHA₂DS₂-VA Score

Stroke risk score in atrial fibrillation, with the sex-neutral CHA₂DS₂-VA used by ESC 2024.

For healthcare professionalsCardiology scoresv1.0.0

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

years
Sex
Heart failure (or LV dysfunction)
Hypertension
Diabetes
Previous stroke, TIA or thromboembolism
Vascular disease (MI, peripheral artery disease, aortic plaque)

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

CHA₂DS₂-VASc (Lip 2010); CHA₂DS₂-VA (ESC 2024)

C 1, H 1, A₂ (≥75) 2, D 1, S₂ 2, V 1, A (65–74) 1, Sc (female) 1

ESC 2024 removed female sex as a risk modifier (CHA₂DS₂-VA); other guidelines still use CHA₂DS₂-VASc with sex-specific thresholds.

Who it is for
Adults with non-valvular atrial fibrillation or flutter.
Version
1.0.0

How this calculator works

Where the formula comes from

  • CHA₂DS₂-VASc was proposed by Lip and colleagues in 2010 by refining the 2006 Birmingham/NICE stroke risk schema and comparing it with other schemas in 1,084 patients with atrial fibrillation from the Euro Heart Survey.[1]
  • In that cohort all the schemas compared had modest predictive value; the new schema had a C-statistic of 0.606, and no thromboembolic events occurred in the patients it classified as low risk.[1]

The inputs

  • Points: congestive heart failure or left ventricular dysfunction 1, hypertension 1, age 75 or over 2, diabetes 1, previous stroke, TIA or thromboembolism 2, vascular disease 1, age 65–74 1 and female sex 1.[1]
  • Vascular disease covers previous myocardial infarction, peripheral artery disease or aortic plaque.[1]

Versions and alternatives

  • It extends the earlier CHADS₂ score by adding vascular disease, age 65–74 and female sex, and by giving age 75 or over two points.[1][2]
  • The 2024 ESC guideline uses CHA₂DS₂-VA, which keeps the same points but removes the sex category.[3]

Where accuracy falls (published evidence)

  • A 2022 meta-analysis of stroke risk scores in more than 6 million patients with atrial fibrillation found only modest discrimination for CHA₂DS₂-VASc.[4]

What guidelines say

  • ESC 2024 recommends oral anticoagulation at a CHA₂DS₂-VA score of 2 or more and says it should be considered at a score of 1, as part of shared decision-making.[3]
  • The 2023 ACC/AHA/ACCP/HRS guideline recommends anticoagulation when the estimated annual thromboembolic risk is 2% or more, for example a CHA₂DS₂-VASc score of 2 or more in men or 3 or more in women.[5]

Sources

  1. Lip 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;137(2):263–272. doi:10.1378/chest.09-1584
  2. Gage 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;285(22):2864–2870. doi:10.1001/jama.285.22.2864
  3. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314–3414. doi:10.1093/eurheartj/ehae176
  4. van der Endt VHW, Milders J, Penning de Vries BBL, et al. Comprehensive comparison of stroke risk score performance: a systematic review and meta-analysis among 6 267 728 patients with atrial fibrillation. Europace. 2022;24(11):1739–1753. doi:10.1093/europace/euac096
  5. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149(1):e1–e156. doi:10.1161/CIR.0000000000001193

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate CHA₂DS₂-VASc

Inputs

Age
72 years
Sex
Female
Heart failure (or LV dysfunction)
No
Hypertension
Yes
Diabetes
No
Previous stroke, TIA or thromboembolism
No
Vascular disease (MI, peripheral artery disease, aortic plaque)
No

Result

CHA₂DS₂-VASc
3 of 9
CHA₂DS₂-VA (ESC 2024, no sex point)
2 of 8

CHA₂DS₂-VA 2 or more: ESC 2024 recommends oral anticoagulation be considered/recommended

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Anticoagulation decisions also weigh bleeding risk and patient preference.
  • Not for valvular AF (moderate–severe mitral stenosis or mechanical valves).

References

  1. Lip 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;137(2):263–272. doi:10.1378/chest.09-1584
  2. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314–3414. doi:10.1093/eurheartj/ehae176

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