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.