What Is a CHADS2 Score?

Atrial fibrillation (AFib) is a condition that makes your heart beat out of rhythm and sometimes too fast. It can make you feel weak or short of breath.

AFib can lead to other health problems, too. One of the main issues is that the unsteady heartbeat can make the blood inside your heart pool and form clots. They may move through your bloodstream into your brain, where they can block the flow of blood and cause a stroke.

If you have AFib, your doctor can recommend a few things to help prevent that. For example, if your chances of a stroke aren’t too high, they might recommend aspirin to keep blood clots from forming. If you need stronger medicine to prevent clots, several kinds of prescription drugs can help.

A measure called your CHADS2 score can help your doctor figure out how likely you are to have a stroke -- and decide if you need to take something to help prevent one. It doesn’t involve lab tests or anything like that. It’s basically a series of questions.

Your CHADS2 Score

Each letter in the name represents something that may raise your chances of having a stroke. For each one that applies to you, you get 1 or 2 points:

C: Congestive heart failure(when your heart can’t pump blood the way it should). If you have this, it counts for 1 point.

H: High blood pressure. Do you have this? That’s a point.

A: Age. Are you 75 years old or older? If so, that gives you a point.

D: Diabetes. If you have this, that’s a point.

S: Stroke. If you’ve had a stroke or a transient ischemic attack (TIA) -- sometimes called a mini-stroke -- that gives you 2 points.

Your score will be between 0 and 6 points:

Zero: You are at low risk for a stroke. You may not need any treatment, or your doctor might just want you to take aspirin.

One point: You have a medium risk of stroke. You should take aspirin or prescription blood thinners -- your doctor will decide which one.

Two or more points: Your odds of having a stroke are medium to high, and your doctor probably will prescribe a blood thinner. You may hear your doctor use the medical term for that kind of medicine: oral anticoagulant.


What Is the CHA2DS2-VASc?

If your doctor wants to look at a few more things, this measure starts with the same questions as CHADS2, then adds three more:

V: Vascular disease(a problem with your blood vessels). If you have this, that counts for 1 point.

A: Age. Are you 65 to 74 years old? If so, that gives you a point.

Sc: Sex category, which is another way to say gender. If you’re a woman, that’s 1 point.

The total of these plus your CHADS2 score can be up to 9 points. The results scale is the same as for CHADS2.

In 2014, the American Heart Association, American College of Cardiology, and Heart Rhythm Society together released guidelines that use this test to predict the chances of a stroke for people with AFib. In 2016, The European Society of Cardiology adopted this scoring system as well.

But some doctors have different views about which system works best for which people. For instance, some doctors think CHA2DS2-VASc works better for people who have lower odds of a stroke. But some researchers aren’t convinced that it’s really better than CHADS2. For one thing, they doubt that being female affects someone’s chances of having a stroke.

One group of researchers found that CHADS2 did a better job with people who were age 65 or older. In that study, people whose CHADS2 score was 3 or higher were much more likely to have a stroke than those who scored 1 or 2.

Scientists are studying another version of CHADS2 called R2CHADS2. The R stands for renal failure, also known as kidney failure. This is because researchers have found that kidney disease is linked to your odds of a stroke. With R2CHADS2, you add 2 points if you have chronic kidney disease. This system needs more study to help doctors learn how to use it.

Other Uses for CHADS2

Even though CHADS2 was designed for people who have AFib, some doctors think it might work for other heart conditions as well.

One study found that CHADS2 may help predict the chances of a heart attack in people who have coronary artery disease. That happens when the vessels that bring blood to your heart are blocked and your heart can’t get the blood and oxygen it needs.

WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on February 08, 2020



Mayo Clinic: “Atrial fibrillation,” “Reduce your risk of stroke if you have atrial fibrillation,” “Coronary artery disease.”

Heart Foundation: “Aspirin.”

Mayo Clinic Health Letter: “CHADS2 score.”

UCSF Cardiology: “Atrial Fibrillation Medication Management.”

American College of Cardiology: “HAS-BLED Tool -- What is the Real Risk of Bleeding in Anticoagulation?”

Clinical Interventions in Aging: “CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation.”

Journal of the American Heart Association: “Prognostic Value of the CHADS2 Score for Adverse Cardiovascular events in Coronary Artery Disease Patients Without Atrial Fibrillation -- A Multi-Center Observational Cohort Study.”

Circulation: “Renal Dysfunction as a Predictor of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation.”

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