CHA 2 DS 2 -VASc score

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The CHADS 2 Score or the further development of the CHA 2 DS 2 -VASc Score is a clinical risk analysis for the occurrence of a stroke in people with atrial fibrillation , a common cardiac arrhythmia. This evaluation standard is used to decide which patients benefit from long-term blood-thinning therapy ( oral anticoagulation ).

With atrial fibrillation, blood clots ( thrombi ) can form in the atrium , which can then lead to acute closure of the arteries supplying the brain ( thromboembolism ) and thus to a stroke. This risk must be weighed against the risk of a bleeding complication under blood-thinning medication, with the above scorings helping. The CHA 2 DS 2 -VASc Score has been evaluated in numerous studies.

 
feature Points
C.  Heart failure ( engl. C ongestive heart failure ) 1
H Hypertension : arterial blood pressure ≥140 / 90 mmHg or drug treatment 1
A. Age ≥75 years 1
D. Diabetes mellitus 1
S 2 Former stroke ( stroke ), or TIA or thromboembolism 2
Risk per year
CHADS 2 score Stroke risk in% 95% confidence interval
0 1.9 01.2-3.0
1 2.8 02.0-3.8
2 4.0 03.1-5.1
3 5.9 04.6-7.3
4th 8.5 06.3-11.1
5 12.5 08.2-17.5
6th 18.2 10.5-27.4

differences

Compared to the CHADS 2 score, the CHA 2 DS 2 -VASc score differentiates more finely with regard to age. In addition, other risk factors such as cardiovascular diseases are recorded under point V. In women under 65 years of age who do not have any other risk factors, the female gender is not an independent risk factor (score = 0 points). The highest achievable value for the CHADS 2 score is 6 points, for the CHA 2 DS 2 -VASc score 9 (a patient receives either two points for an age greater than 75 years or one point for an age between 65 and 74 years).

 
feature Points
C.  Heart failure ( engl. C ongestive heart failure ) 1
H Hypertension 1
A 2 Age ≥75 years 2
D. Diabetes mellitus 1
S 2 Previous stroke , TIA, or thromboembolism 2
V Vascular diseases such as PAOD or heart attack 1
A. Age 65–74 years 1
Sc Female gender ( English S ex c ategory ) 1
Risk per year
CHA 2 DS 2 -VASc score Stroke risk in% 95% confidence interval
0 0 -
1 1.3 -
2 2.2 -
3 3.2 -
4th 4.0 -
5 6.7 -
6th 9.8 -
7th 9.6 -
8th 6.7 -
9 15.2 -

Treatment guidelines

The CHA 2 DS 2 -VASc Score has been recommended in the guidelines of the European Society of Cardiology for the treatment of atrial fibrillation since 2012. Since 2014, the American College of Cardiology / American Heart Association Task Force has also recommended the use of the CHA 2 DS 2 -VASc score.

The European Society of Cardiology (ESC2016) recommend oral anticoagulation therapy for patients with a CHA 2 DS 2 -VASc score of more than 2 points for men or more than 3 points for women (class 1A recommendation). The therapy is carried out either with vitamin K antagonists or with the newer (direct) oral anticoagulants, NOAC or DOAC for short, such as dabigatran , rivaroxaban , edoxaban or apixaban . Anticoagulation should be considered in patients with one point (men) or 2 points (women) (Class IIaB recommendation). A therapy with ASA has proven to be ineffective in stroke prophylaxis and is not an alternative for one point either. With 0 points, there is no indication for anticoagulation (class III recommendation)

Risk of bleeding

The individual decision on anticoagulant therapy should not only be based on the scores discussed here. Scoring systems were also developed to evaluate the risk of bleeding compared to the risk of stroke, such as B. the HEMORR 2 HAGES or HAS-BLED score. The latter is recommended in the ESC guidelines.

Individual evidence

  1. BF Gage, C. van Walraven, L. Pearce: Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin . In: Circulation . 110, No. 16, 2004, pp. 2287-92. doi : 10.1161 / 01.CIR.0000145172.55640.93 . PMID 15477396 .
  2. a b B. F. Gage BF, AD Waterman, W. Shannon, M. Boechler, MW Rich, MJ Radford: Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation . In: JAMA . 285, No. 22, 2001, pp. 2864-70. doi : 10.1001 / jama.285.22.2864 . PMID 11401607 .
  3. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). . Retrieved April 2, 2016.
  4. ^ AJ Camm, GY Lip, R. De Caterina, I. Savelieva, D. Atar, SH Hohnloser, G. Hindricks, P. Kirchhof; European Society of Cardiology Committee for Practice Guidelines; Document reviewers. 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 . Europace. October 2012; 14 (10): 1385-413.
  5. ^ European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, AJ Camm, P. Kirchhof, GY Lip, U. Schotten, I. Savelieva, S. Ernst, IC Van Gelder, N. Al-Attar, G. Hindricks, B. Prendergast, H. Heidbuchel, O. Alfieri, A. Angelini, D. Atar, P. Colonna, R. De Caterina, J. De Sutter, A. Goette, B. Gorenek, M. Heldal, SH Hohloser, P. Kolh, Jean-Yves Le Heuzey, P. Ponikowski, FH Rutten. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) . European Heart Journal, October 2010; 31 (19): 2369-429.
  6. Atrial Fibrillation (Management of) [Current versions available to download]. European Society of Cardiology, archived from the original on November 15, 2008 ; accessed on February 28, 2018 .
  7. CT January, LS Wann, JS Alpert, H. Calkins, JE Cigarroa, JC Jr. Cleveland JC, JB Conti, PT Ellinor, MD Ezekowitz, ME Field, KT Murray, RL Sacco, WG Stevenson, PJ Tchou, CM Tracy, CW Yancy; American College of Cardiology / American Heart Association Task Force on Practice Guidelines. 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 . Journal of the American College of Cardiology. December 2, 2014; 64 (21): e1-76.
  8. JA Cairns, S. Connolly, S. McMurtry, M. Stephenson, M. Talajic; Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter . Canadian Journal of Cardiology. January-February 2011; 27 (1): 74-90. PMID 21329865 .

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