CHA2DS2-VASc Stroke Risk Score in Atrial Fibrillation
Add the eight CHA2DS2-VASc items — heart failure, hypertension, age, diabetes, prior stroke, vascular disease, sex — for a total out of 9 and its risk band.
CHA2DS2-VASc
—
CHA2DS2-VASc: stroke risk in atrial fibrillation
The CHA2DS2-VASc estimates yearly stroke risk in patients with non-valvular atrial fibrillation, and that estimate is what tells you whether oral anticoagulation is worth starting. Each letter carries points: Congestive heart failure (1), Hypertension (1), Age ≥75 (2), Diabetes (1), Stroke/TIA/thromboembolism prior (2), Vascular disease — MI, PAD, aortic plaque (1), Age 65–74 (1), Sex category female (1). Totals run from 0–9. The decision threshold is ≥2 in men or ≥3 in women: anticoagulate (DOAC preferred, or warfarin); a score of 0 (man) / 1 (woman, sex point only): do not anticoagulate. Example: a 70-year-old man with hypertension and diabetes scores 1+1+1 = 3, so anticoagulation is indicated.
Clinical context
The ESC, AHA/ACC and the Brazilian Society of Cardiology (SBC) all point to it as the standard way to stratify thromboembolic risk in AF. It took over from the older CHADS2 once vascular disease, sex and a wider age range were folded in. You will see it in cardiology clinics, in primary prevention, when weighing a DOAC against warfarin, and in the day-to-day management of older patients with AF. Because the number shifts as people age and pick up new comorbidities, it is worth recalculating from time to time.
FAQ
Does female sex alone justify anticoagulation? No. A woman with the sex point and nothing else (total = 1) does not need anticoagulation. Current guidance is to start counting from ≥2 additional points in women.
Does it apply to valvular AF? No. With mitral stenosis or a mechanical valve, anticoagulation is required whatever the score says.
Why score 2 points for prior stroke? A previous TIA or stroke is the strongest single predictor of another one, and it roughly doubles the absolute annual risk, so it carries double weight.
Should I combine with HAS-BLED? Yes. CHA2DS2-VASc tells you how much anticoagulation stands to help, while HAS-BLED flags the bleeding risk you need to keep an eye on. On its own, HAS-BLED is not a reason to withhold treatment.
Related Tools
ASCVD Cardiovascular Risk (Simplified)
Simplified 10-year ASCVD estimate from age, sex, smoking, diabetes, treated hypertension and total cholesterol, returning a percentage and its risk band.
Appraisal Ratio (Treynor-Black)
Computes the Treynor-Black appraisal ratio: a manager's alpha divided by the standard deviation of residual risk, the part not explained by the market. It measures the quality of security selection per unit of specific risk taken, and is the central metric for deciding how much to allocate to an active strategy. The higher it is, the better the manager extracts abnormal return without taking on too much diversifiable risk. Enter the alpha and the residual standard deviation.
Framingham Cardiovascular Risk
Estimates 10-year cardiovascular event risk using the Framingham score (age, cholesterol, BP, smoking, diabetes).
Burke Ratio
Computes the Burke ratio: the excess return over the risk-free rate divided by the square root of the sum of squared drawdowns. Unlike the Sharpe ratio, which penalizes all volatility, Burke focuses only on the falls, and by squaring each drawdown it punishes deep falls more than shallow ones. It's one of the tail-risk-adjusted performance metrics. Enter the portfolio return, the risk-free rate and the list of drawdowns in percent.
R-Multiple
Computes the R-multiple of a long trade: the result expressed in multiples of the initial risk, (exit − entry) divided by (entry − stop). It's system traders' favorite unit of measure, popularized by Van Tharp, because it normalizes any trade by the risk it took — a 3R gain means profiting three times what was risked. Thinking in R, rather than in currency, keeps the focus on risk management. Enter the entry, stop and exit prices.
DVA — Debit Valuation Adjustment
Computes the DVA (Debit Valuation Adjustment), the mirror image of CVA seen from the other side. While CVA discounts value for the risk of the counterparty failing, DVA recognizes the counterintuitive benefit of the institution's own default risk: if it might not pay its obligations, that effectively reduces the liability. It's the piece that makes derivative pricing symmetric between the two parties. The calculation follows the same structure as CVA, but uses the expected negative exposure and the own default probability. Enter the exposure and credit data.
The results provided by this tool are for general informational and educational purposes only and do not constitute professional, financial, medical, legal, tax or accounting advice. Always confirm important decisions with a qualified professional and official sources.