Also known as CHA2DS2-VASc, CHA2DS2VASc, CHADS2-VASc, CHADSVASC

Stroke risk in atrial fibrillation.

Clinically reviewed bySamira Bahrainy, MDNot an endorsement of any individual result, and no substitute for the treating clinician’s judgement.

Reviewed Aug 19, 2026Version 1.3.0Next review Aug 19, 2028

Pair this assessment

Add HAS-BLED

Reuse entered values for a separate bleeding-risk assessment.

New to this score?

Applies to / doesn’t apply to3

Applies to: Non-valvular atrial fibrillation only. Excludes moderate-to-severe rheumatic mitral stenosis and mechanical heart valves.

Does not apply if:

Hypertrophic cardiomyopathy.
Cardiac amyloidosis.
Valvular atrial fibrillation — moderate-to-severe rheumatic mitral stenosis or a mechanical heart valve — which falls outside “non-valvular AF”.

CHA₂DS₂-VASc inputs

Age

Sex

Congestive heart failure

Clinical heart failure, or objective evidence of moderate-to-severe LV dysfunction. Reduced ejection fraction is not required.

Hypertension history

Resting BP >140/90 mmHg on at least two occasions, or on antihypertensive treatment. History, not current control.

Diabetes mellitus

Fasting glucose ≥126 mg/dL, or on hypoglycaemic treatment.

Prior stroke

Any prior ischaemic stroke.

TIA, peripheral or pulmonary embolism

Asked separately from stroke because HAS-BLED’s criterion counts none of these. Scores the same +2 and does not add to it.

Vascular disease

Coronary artery disease — prior MI, angina, prior PCI, or CABG — or peripheral artery disease; or complex aortic plaque on imaging (mobile, ulcerated, pedunculated, or ≥4 mm thick), per ESC 2024.

What this score estimates

Estimates annual ischaemic stroke risk in patients with non-valvular atrial fibrillation who are not taking an anticoagulant. The score runs 0–9; the point for female sex is included in the total and the anticoagulation threshold differs by sex rather than the score being adjusted.

Pearls & pitfalls

Discrimination is modest — C-statistic approximately 0.6–0.7. This is a screening tier, not a precise individual estimate.
The derivation cohort was small (n=1,084) with 31% lost to follow-up at one year. Credibility rests on the later validations (Olesen n=73,538; Friberg n=182,678).
The displayed rates come from Friberg’s non-anticoagulated subgroup (n=90,490), not its full cohort — none of those patients were taking an anticoagulant, which is what makes the figures describe untreated risk.
The rate at a given score varies across populations even for the same endpoint. At a score of 2, the 2023 ACC/AHA guideline reports annual ischaemic-stroke rates across 15 validation cohorts of below 1% in four cohorts, 1–2% in six, and above 2% in five (guideline §8, Figure 9); the ~2.2% per year shown here is the point estimate from Friberg’s non-anticoagulated cohort.
Anticoagulation decisions should not turn on whether the atrial fibrillation is paroxysmal or permanent: the risk is similar across patterns.

Risk factors the score does not count:

Obesity
Poorly controlled hypertension
eGFR below 45, or proteinuria
Enlarged left atrium

What the guidelines say

2023 ACC/AHA AF guideline

Keeps the point for female sex and applies a sex-specific threshold, at a score of 2 in men and 3 in women.

View guideline source ↗

2024 ESC AF guideline

Advocates the CHA₂DS₂-VA formulation, which removes the sex criterion and scores 0–8.

Guideline positions are stated as published. Curie.MD Calc does not publish treatment direction.

Where this comes from

How it’s scored

Age<65 0 · 65–74 +1 · ≥75 +2

SexMale 0 · Female +1

Congestive heart failureNo 0 · Yes +1Clinical heart failure, or objective evidence of moderate-to-severe LV dysfunction. Reduced ejection fraction is not required.

Hypertension historyNo 0 · Yes +1Resting BP >140/90 mmHg on at least two occasions, or on antihypertensive treatment. History, not current control.

Diabetes mellitusNo 0 · Yes +1Fasting glucose ≥126 mg/dL, or on hypoglycaemic treatment.

Prior strokeNo 0 · Yes +2Any prior ischaemic stroke.

TIA, peripheral or pulmonary embolismNo 0 · Yes +2Asked separately from stroke because HAS-BLED’s criterion counts none of these. Scores the same +2 and does not add to it.

Vascular diseaseNo 0 · Yes +1Coronary artery disease — prior MI, angina, prior PCI, or CABG — or peripheral artery disease; or complex aortic plaque on imaging (mobile, ulcerated, pedunculated, or ≥4 mm thick), per ESC 2024.

What was observed

0~0.2 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

1~0.6 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

2~2.2 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

3~3.2 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

4~4.8 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

5~7.2 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

6~9.7 ischaemic strokes per 100 patient-years in non-anticoagulated patients · Friberg 2012 cohort

≥7~10.8–12.2 ischaemic strokes per 100 patient-years in non-anticoagulated patients (scores ≥7) · Friberg 2012 cohort

References

Lip GYH, Nieuwlaat R, Pisters R, et al. Chest. 2010;137(2):263-72. View source ↗
Friberg L, Rosenqvist M, Lip GYH. Eur Heart J. 2012;33(12):1500-10. View source ↗
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. View source ↗

Live result

CHA₂DS₂-VASc

0 of 8 answeredAnswer the remaining 8 to see the score

Not applicable in hypertrophic cardiomyopathy or cardiac amyloidosis — both current guidelines recommend against basing stroke-prevention decisions on this score in those patients.

Document your decision

Answer the inputs to see the score

CHA₂DS₂-VASc Calculator