CHA2DS2-VASc is not a one-time score. A patient with atrial fibrillation who scores low at diagnosis moves up a point on turning 65 and again at 75, and with any new diagnosis of hypertension, diabetes, heart failure, vascular disease or stroke.
Many patients with atrial fibrillation are left off anticoagulation because they were low risk when first seen and never rescored. Recalculating at each review, and whenever a new diagnosis is added, is the simplest way to catch them.
- Recalculate CHA2DS2-VASc at every review of a patient with atrial fibrillation.
- Rescore when the patient turns 65 or 75.
- Rescore whenever hypertension, diabetes, heart failure, vascular disease or stroke is newly diagnosed.
- Document the score and the anticoagulation decision each time.
Why it matters
Most missed anticoagulation is a score that was right once and never updated.
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