title: Impact of the CHA2DS2-VASc score on anticoagulation recommendations for atrial fibrillation.
abstract: BACKGROUND
  The Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke (CHADS(2)) score is used to predict the need for oral anticoagulation for stroke prophylaxis in patients with atrial fibrillation. The Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category (CHA(2)DS(2)-VASc) schema has been proposed as an improvement. Our objective is to determine how adoption of the CHA(2)DS(2)-VASc score alters anticoagulation recommendations.
  
  
  METHODS
  Between 2004 and 2008, 1664 patients were seen at the University of Virginia Atrial Fibrillation Center. We calculated the CHADS(2) and CHA(2)DS(2)-VASc scores for each patient. The 2006 American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines for atrial fibrillation management were used to determine anticoagulation recommendations based on the CHADS(2) score, and the 2010 European Society of Cardiology guidelines were used to determine anticoagulation recommendations based on the CHA(2)DS(2)-VASc score.
  
  
  RESULTS
  The average age was 62±13 years, and 34% were women. Average CHADS(2) and CHA(2)DS(2)-VASc scores were 1.1±1.1 and 1.8±1.5, respectively (P<.0001). The CHADS(2) score classified 33% as requiring oral anticoagulation. The CHA(2)DS(2)-VASc score classified 53% as requiring oral anticoagulation. For women, 31% had a CHADS(2) score ≥ 2, but 81% had a CHA(2)DS(2)-VASc score ≥ 2 (P = .0001). Also, 32% of women with a CHADS(2) score of zero had a CHA(2)DS(2)-VASc score ≥ 2. For men, 25% had a CHADS(2) score ≥ 2, but 39% had a CHA(2)DS(2)-VASc score ≥ 2 (P<.0001).
  
  
  CONCLUSIONS
  Compared with the CHADS(2) score, the CHA(2)DS(2)-VASc score more clearly defines anticoagulation recommendations. Many patients, particularly older women, are redistributed from the low- to high-risk categories.
authors.affiliation: University of Virginia Health System, Charlottesville, VA 22908, USA. Pkm5f@virginia.edu
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Mason
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Lake
authors.forename: John P
authors.initials: JP
authors.lastname: DiMarco
authors.forename: John D
authors.initials: JD
authors.lastname: Ferguson
authors.forename: J Michael
authors.initials: JM
authors.lastname: Mangrum
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bilchick
authors.forename: Liza P
authors.initials: LP
authors.lastname: Moorman
authors.forename: J Randall
authors.initials: JR
authors.lastname: Moorman
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D012737:Sex Factors; D012955:Societies, Medical; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014481:United States; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin