Clinical Calculators

CHA₂DS₂-VASc Score

Estimates the risk of thromboembolism in atrial fibrillation from heart failure, hypertension, age, diabetes, previous stroke, vascular disease and sex

7 items left

Congestive heart failure or left ventricular dysfunction
Hypertension (including a history of it)
18 to 100
years
Diabetes mellitus
Previous stroke, transient ischemic attack (TIA) or thromboembolism
Vascular disease

Any of: a previous myocardial infarction, peripheral artery disease, or aortic plaque

Sex

Cautions

  • For people with non-valvular atrial fibrillation. In deciding who should receive anticoagulation, the Japanese guideline uses the CHADS₂ score, and its 2024 focused update says the 2020 recommendation to start anticoagulation at a CHADS₂ score of 1 or more is still valid. This score is a "may be considered" option (class of recommendation IIb), lowered from IIa in the 2020 edition.
  • The 2024 Japanese edition also lists the HELT-E₂S₂ score (class of recommendation IIa), which was built from Japanese data. Heart failure and diabetes are not among its items.
  • The 2020 guideline also recommends using the score without sex (female), the CHA₂DS₂-VA score (maximum 8 points; class IIa). It is this score minus the 1 point for female sex.
  • The way heart failure is entered follows the table in the Japanese guideline (congestive heart failure/left ventricular dysfunction). In CHADS₂, heart failure means a recent exacerbation of heart failure (within the preceding 100 days, per the Japanese guideline).
  • Also look at the risk of bleeding (HAS-BLED and similar scores). The score alone does not decide whether to anticoagulate.

References

  1. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. 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. (original not seen) PMID: 19762550, DOI: 10.1378/chest.09-1584[Original article]
  2. Ono K, Iwasaki YK, Akao M, et al. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias (the 2020 revised edition of the guideline of the Japanese Circulation Society and the Japanese Heart Rhythm Society). J Arrhythm. 2022;38(6):833-973. (Table 29, Table 31, 5.3.1.1.5) PMID: 36524037, DOI: 10.1002/joa3.12714, https://pmc.ncbi.nlm.nih.gov/articles/PMC9745564/[Guideline]
  3. Iwasaki YK, Noda T, Akao M, et al. JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias (the 2024 focused update of the JCS/JHRS guideline). J Arrhythm. 2025;41(3):e70033. (Table 19, III.1) PMID: 40524851, DOI: 10.1002/joa3.70033, https://pmc.ncbi.nlm.nih.gov/articles/PMC12168493/[Guideline]

Checked on: 2026-10-15

Disclaimer

This calculation is intended to support the judgment of healthcare professionals. Results are for reference only; decisions about diagnosis and treatment must be made by the responsible healthcare professional. The values you enter never leave your device.