Also known as CHA2DS2-VA, CHA2DS2VA, CHADS-VA
Stroke risk in atrial fibrillation, without the sex point (ESC 2024).
Clinically reviewed bySamira Bahrainy, MDNot an endorsement of any individual result, and no substitute for the treating clinician’s judgement.
Reviewed Nov 6, 2026Version 1.0.0Next review Nov 6, 2029
Applies to / doesn’t apply to3
Applies to: Adults with atrial fibrillation or atrial flutter. Excludes a mechanical heart valve and moderate-to-severe mitral stenosis, which the 2024 ESC guideline addresses separately.
- Hypertrophic cardiomyopathy.
- Cardiac amyloidosis.
- A mechanical heart valve or moderate-to-severe mitral stenosis. These patients are addressed separately by AF guidelines.
Symptoms and signs of heart failure at any ejection fraction (HFpEF, HFmrEF or HFrEF), or asymptomatic LVEF ≤40%.
Resting blood pressure >140/90 mmHg on at least two occasions, or current antihypertensive treatment.
Type 1 or type 2 diabetes by currently accepted diagnostic criteria, or treatment with glucose-lowering therapy.
Prior stroke, transient ischaemic attack (TIA), or arterial thromboembolism. The ESC wording is arterial: pulmonary embolism is not listed.
Coronary artery disease (prior MI, angina, coronary revascularization, or significant CAD on angiography or cardiac imaging), or peripheral vascular disease (intermittent claudication, prior revascularization for PVD, intervention on the abdominal aorta, or complex aortic plaque on imaging: mobile, ulcerated, pedunculated, or ≥4 mm thick).
What this score estimates
Counts thromboembolic risk factors in atrial fibrillation, as defined in the 2024 ESC guideline: CHA₂DS₂-VASc without the point for female sex. The score runs 0–8. Each score is shown with the ischaemic stroke rate observed in a Finnish cohort of untreated patients in the first year after AF diagnosis.
Pearls & pitfalls
17
- No derivation of its own: CHA₂DS₂-VA is CHA₂DS₂-VASc (Lip 2010) with the sex point removed, as defined in the 2024 ESC guideline. The point weights were not refitted.
- The rates come from FinACAF: Finnish patients aged 20 and over with newly diagnosed atrial fibrillation or flutter, followed for at most one year, with follow-up stopped when an anticoagulant was started. They describe untreated risk, not the risk of a patient already on anticoagulation.
- Rates fell over time in the same cohort: at a score of 5, 20.9 per 100 patient-years in 2007–08 against 11.2 in 2017–18. The 2017–18 figures are shown.
- The scores behind the rates were coded from Finnish registry diagnoses, not from the 2024 ESC definitions used here. For example, the cohort's prior-event item counted stroke or TIA but not other arterial thromboembolism.
- Scores of 6 to 8 rest on few events: the confidence intervals are wide, and the rate at 7 is lower than at 6.
- Discrimination is modest. Clinical risk scores in atrial fibrillation have c-statistics of about 0.65, and FinACAF found only marginal differences between CHA₂DS₂-VA and CHA₂DS₂-VASc.
- Not interchangeable with CHA₂DS₂-VASc. A woman's CHA₂DS₂-VA is one point lower than her CHA₂DS₂-VASc, and the two calculators show rates from different cohorts.
- In Danish registry data, female sex raised thromboembolic risk in patients with two or more other risk factors (Nielsen 2018). This score does not capture that.
- Atrial fibrillation is a thromboembolic risk factor whether it is paroxysmal, persistent or permanent (2024 ESC guideline).
Risk factors the score does not count:
- Cancer
- Chronic kidney disease
- Ethnicity
- Biomarkers (troponin, BNP)
- Enlarged left atrium
- Hyperlipidaemia
- Smoking
- Obesity
What the guidelines say
4
Uses CHA₂DS₂-VA, which removes the sex criterion, describing female sex as an age-dependent stroke risk modifier rather than a risk factor in itself.
View guideline source ↗Treats a score of 2 or more as indicating elevated thromboembolic risk for decisions on oral anticoagulation, and a score of 1 as an indicator of elevated thromboembolic risk too, with that decision following a patient-centred, shared care approach. It makes no score-specific statement at 0.
View guideline source ↗Proposes the score where no other locally validated tool exists, and states that the absolute risk at which to start anticoagulation in an individual cannot be estimated from population-level studies.
View guideline source ↗Keeps CHA₂DS₂-VASc with the point for female sex, at a score of 2 or more in men and 3 or more in women, and does not use CHA₂DS₂-VA.
View guideline source ↗Guideline positions are stated as published. Curie.MD Calc does not publish treatment direction.
Where this comes from
5
How it’s scored
What was observed
References
- Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314-3414. View source ↗
- Lip GYH, Nieuwlaat R, Pisters R, et al. Chest. 2010;137(2):263-72. View source ↗
- Teppo K, Lip GYH, Airaksinen KEJ, et al. Comparing CHA2DS2-VA and CHA2DS2-VASc scores for stroke risk stratification in patients with atrial fibrillation (FinACAF). Lancet Reg Health Eur. 2024;43:100967. View source ↗
- Nielsen PB, Skjøth F, Overvad TF, et al. Circulation. 2018;137(8):832-840. View source ↗
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. View source ↗