Atrial fibrillation — stroke risk (2024 ESC, without sex)
Heart failure (symptoms/signs, or LVEF ≤40%)
Hypertension (treated, or >140/90 mmHg twice)
Diabetes
Previous stroke, TIA, or arterial thromboembolism
Vascular disease (coronary or peripheral artery disease)
Age
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About this score
When to use
Estimates the risk of stroke and thromboembolism in atrial fibrillation without a sex criterion; the 2024 ESC guideline introduced it for use in the absence of other locally validated alternatives. [1]
Pearls and pitfalls
• Heart failure counts with symptoms or signs regardless of ejection fraction, or with an asymptomatic LVEF of 40% or less; hypertension counts when treated or above 140/90 mmHg on two occasions. [1]
• In a UK primary-care cohort of 78,852 people with atrial fibrillation not taking anticoagulants, women and men did not differ in ischaemic stroke or arterial thromboembolism (adjusted hazard ratio 1.00). [2]
• In the same cohort the clinical risk scores were only modest predictors; CHA₂DS₂-VA discriminated the composite outcome slightly better than CHA₂DS₂-VASc (area under the curve 0.651 vs 0.639). [2]
About the condition
Atrial fibrillation is associated with ischaemic stroke and systemic embolism; the score informs guideline-based oral-anticoagulation decisions but does not make an individual treatment decision. [1]
Summarised from the numbered sources under Evidence. Check the source before relying on a statement.
Evidence
[1] Original publication
Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Introduces CHA₂DS₂-VA (Table 10) for thromboembolic risk assessment in the absence of other locally validated alternatives.
European Heart Journal, 2024
Open source
[2] Validation
Champsi A, Mobley AR, Subramanian A, et al. Gender and contemporary risk of adverse events in atrial fibrillation. UK primary-care cohort of 78,852 patients with AF; CHA₂DS₂-VA performed at least as well as CHA₂DS₂-VASc.
European Heart Journal, 2024
Open source
Last reviewed: 2026-10
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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.