CHADS2 and CHA2DS2 VASc Scoring for AF

Описание: Description: https://johnsonfrancis.org/profession...
https://johnsonfrancis.org/profession...
Discussion on CHADS2 and CHA2DS2-VASc Scoring for AF.
CHADS2 score was developed to assess the risk of thromboembolism in nonvalvular atrial fibrillation.
Scores were allotted to various risk factors as follows:
Congestive heart failure: 1
History of hypertension: 1
Age above 75: 1
Diabetes: 1
Stroke / TIA: 2
Anticoagulation (typically Warfarin) is indicated when CHADS2 score is 2 or more. That would mean that anyone who had stroke or TIA along with atrial fibrillation will need life-long anticoagulation.
As age above 75 is a risk factor, any one of hypertension, diabetes mellitus or congestive heart failure in this age group will become an indication for anticoagulation in the presence of AF.
Valvar atrial fibrillation is atrial fibrillation in the presence of mitral stenosis or artificial heart valves.
Other valvular lesions like mitral regurgitation, aortic stenosis and regurgitation do not result in low flow in left atrium. In valvar AF, only vitamin K dependent oral anticoagulants are considered while in non-valvar AF, non-vitamin K dependent oral anticoagulants can also be considered.
CHA2DS2-VASc is another risk factor based point scoring system for atrial fibrillation and is meant for assessing the risk of thromboembolism in nonvalvular atrial fibrillation. Major risk factors are given a score of two points.
Other clinically relevant non-major risk factors are given one point each. Points for each category are as follows.
Congestive heart failure / LV dysfunction: 1
Hypertension: 1
Age 75 or more: 2
Diabetes mellitus: 1
Stroke/TIA/thromboembolism: 2
Vascular disease: 1
Age 65-74: 1
Sex category (female sex): 1
Maximum score: 9
CHA2DS2-VASc score is an improvement from the CHADS2 score. The risk increases as the score increases from 0 to 9. In a study involving over 7300 patients stroke rate was 0 when the score was 0, though there was only one patient in that category.
There were 14 patients with a score of 9 and they had stroke rate of 15.2%. Maximum number of patients had scores of 3 and 4 with 1730 and 1718 patients in these categories. Score 3 had a stroke rate of 3.2% and score 4 had a stroke rate of 4%