CHA2DS2-VASc Predicts Stroke, Thromboembolic Risk in Heart Failure

Heart attack
Heart attack
CHA2DS2-VASc score was associated with risk of ischemic stroke, thromboembolism, and death in patients with incident heart failure.

The CHA2DS2-VASc score proved useful in assessing risk of thromboembolic events in heart failure patients with and without atrial fibrillation (AF), according to a study presented at the European Society of Cardiology 2015 Congress in London.

The score (10 possible points, with higher score meaning higher risk), which is already used in patients with AF to assess stroke and thromboembolic risk, was associated with risk of ischemic stroke, thromboembolism, and death in patients with incident heart failure. For this observational study, the researchers included data on 42,987 patients (21.9% with concomitant AF) who were not receiving anticoagulation and were diagnosed with incident heart failure between 2000 and 2012.

Line Melgaard, MSc, who presented the study at the meeting, and colleagues, found that in patients with AF, the risk for ischemic stroke was 3.1%, thromboembolism was 9.9%, and death was 21.8%, with risk increasing with CHA2DS2-VASc scores. Scores of 1 through 6, respectively, for ischemic stroke with concomitant AF: 4.5%, 3.7%, 3.2%, 4.3%, 5.6%, and 8.4%; without concomitant AF: 1.5%, 1.5%, 2.0%, 3.0%, 3.7%, and 7% and all-cause death with concomitant AF: 19.8%, 19.5%, 26.1%, 35.1%, 37.7%, and 45.5%; without concomitant AF: 7.6%, 8.3%, 17.8%, 25.6%, 27.9%, and 35.0%. 

Those with high CHA2DS2-VASc scores (≥4) had a higher risk of thromboembolism regardless of the presence of AF (for a score of 4, 9.7% vs 8.2% for patients without and with concomitant AF, respectively; overall P<.001 for interaction), suggesting that other factors besides AF are causing stroke and embolic events in people with heart failure. Overall, the CHA2DS2-VASc score performed modestly in the heart failure population with and without AF, but requires further study to better understand the clinical utility of this score in this population.

 “This study won’t change the guidelines, but it does suggest that physicians need to pay attention to the idea that heart-failure patients without AF are at risk of stroke and thromboembolic events and that this risk increases with each additional comorbidity present,” Melgaard told Medscape.


  1. Melgaard L et al. JAMA. 2015; doi:10.1001/jama.2015.10725.