38
Management
Table 9. Some Best Known Published Clinical Scores With
Potential Advantages
Year of Publication
Score Name Score Components Potential Advantages
2001
Congestive heart
failure, hypertension,
age >75 years,
diabetes mellitus,
stroke/transient
ischemia attack/
thromboembolism
(CHADS
2
)
Congestive heart
failure (CHF),
hypertension, age
(≥65 y = 1 point,
≥75 y = 2 points),
diabetes, stroke/TIA
(2 points)
CHADS
2
was superior to existing
risk classification schemes
AFI scheme: C-statistic =
0.68 (0.65–0.71)
SPAF-III scheme: C-statistic =
0.74 (0.71–0.76)
CHADS
2
score: C-statistic =
0.82 (0.80–0.84)
2010
CHA
2
DS
2
-VASc
CHF, hypertension,
age ≥75 y, diabetes,
stroke or TIA, vascular
disease, age 65–74 y,
female sex
Most commonly used and studied,
superior to CHADS
2
. C-statistic =
0.606 (0.513–0.699) for
CHA
2
DS
2
-VASs versus 0.561
(0.450–0.672) for CHADS
2
Improved compared with original
CHADS
2
score
2013
ATRIA
Age (65–74 y = 3
points, 75–84 y =
5 points, ≥85 y = 6
points), hypertension,
diabetes, CHF,
proteinuria, GFR <45
mL/min/1.73 m
2
, sex
Includes more age categories, renal
function, and proteinuria
More patients were classified as low
or high risk but not as well tested
in general.
2017
GARFIELD-AF
Web-based, uses
routinely collected
clinical data, and
includes a total of 16
questions
Web-based tool for predicting
stroke and mortality, includes
the effect of the different
anticoagulants, bleeding risk
and mortality to facilitate shared
decision-making on the potential
benefits/risks of anticoagulation
2016
MCHA
2
DS
2
-VASc
Expanded lower
threshold for age to
50 y (1 point for age
50–74 y)
Validated in Asian cohort
Can further identify Asian AF
patients who may derive benefits
from stroke prevention. In one
study, MCHA
2
DS
2
-VASc was
superior to CHA
2
DS
2
-VASc
C-statistics = 0.708 (0.703–0.712)
vs. 0.689 (0.684–0.694)
