The 2024 European Society of Cardiology atrial fibrillation guideline uses CHA₂DS₂-VA, which removes the point for female sex. Female sex was a risk modifier rather than an independent risk factor, and counting it made the thresholds differ by sex.
In practice, a score of 2 or more on CHA₂DS₂-VA favours anticoagulation, and a score of 1 is the intermediate zone where it should be considered. The US guideline still uses CHA₂DS₂-VASc. Know which score your local protocol uses before reading a threshold off it.
- C: heart failure; H: hypertension; A₂: age ≥75 (2 points); D: diabetes
- S₂: prior stroke, TIA or embolism (2 points); V: vascular disease; A: age 65–74
- CHA₂DS₂-VA ≥2: anticoagulate; 1: consider
- Reassess the score each year as patients age
Why it matters
Thresholds read from the wrong version of the score can move a patient in or out of anticoagulation.
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