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The CHADS2 score has been accepted as a valuable risk assessment tool. More recently, however, it has been recognized that CHADS2 does not include a number of other risk markers that have been identified as being significant, as listed in the Figure. Therefore at the annual conference of the European Society of Cardiology in August 2010 an amended risk scoring system CHA2DS2-VASc, was introduced to include more risk factors and to change the ranking of others.[43] For example, in CHA2DS2-VASc, age >75 years was changed from 1 to 2 points, with age beginning at 65 given 1 point, and for vascular disease and female gender, the peak score is now 9.[44] Finally, initiation of anticoagulation is now recommended for a CHA2DS2-VASc score of ≥2, or perhaps even as low as 1.
CHA2DS2-VASc represents an important improvement over CHADS2; nevertheless, however, as noted in the Figure, this amended scoring system still fails to factor in further additional important factors. Perhaps the most important of these is severe renal dysfunction – in the opinion of the author, the amended score should be the CHA2DS2-VASc-R, with yet another point given for renal dysfunction.[45]
Reiffel JA. Am J Med 2013; 126: 00-00.
[43] Camm AJ, Kirchhof P, Lip GYH, et al. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA). Eur Heart J. 2010;31:2369-2429.
[44] Lip G, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. 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;137:263-272.
[45] Marinigh R, Lane DA, Lip GY. Severe renal impairment and stroke prevention in atrial fibrillation: implications for thromboprophylaxis and bleeding risk. J Am Coll Cardiol. 2011;57:1339-1348.