CHA2DS2-VASc Score
Stratifies stroke risk in non-valvular atrial fibrillation to guide anticoagulation decisions
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; surfaces a disagreement, never overwrites
- Care settings
- Emergency department, Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The CHA2DS2-VASc Score can activate when the transcript or pasted chart context documents any of these:
- New-onset atrial fibrillation
- Atrial flutter
- Anticoagulation decision needed
- Stroke/TIA in AFib patient
- AFib discovered incidentally
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I48.
Note-type scope: it activates on notes whose subject resolves to cardiology, emergency medicine, critical care, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
7 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Patient age | age | years | Scored 1 if 65–74, 2 if ≥75. |
| Biological sex | history |
| Female sex scores +1. |
| History of CHF/LV dysfunction | history | Prior CHF / reduced ejection fraction / cardiomyopathy (CHA2DS2-VASc: 1 point). Asked as: “Does the patient have a history of congestive heart failure or LV dysfunction?” | |
| Hypertension history | history | Diagnosed hypertension, treated or untreated (CHA2DS2-VASc: 1 point). Asked as: “Does the patient have a history of hypertension?” | |
| Prior stroke/TIA/thromboembolism | history | PRIOR stroke / TIA / systemic thromboembolism — not an acute index event (CHA2DS2-VASc: 2 points). Asked as: “Does the patient have a history of prior stroke, TIA, or thromboembolism?” | |
| Vascular disease (MI, PAD, aortic plaque) | history | Prior MI, PAD, or aortic plaque (CHA2DS2-VASc: 1 point). Asked as: “Does the patient have vascular disease (prior MI, peripheral arterial disease, or aortic plaque)?” | |
| Diabetes mellitus | history | Type 1 or type 2 diabetes mellitus (CHA2DS2-VASc: 1 point). Asked as: “Does the patient have diabetes mellitus?” |
Scoring
CHF=1, HTN=1, Age 65-74=1, Age>=75=2, Diabetes=1, Stroke/TIA=2, Vascular disease=1, Female=1
CHF History of CHF/LV dysfunction + HTN Hypertension history + Age Patient age + DM Diabetes mellitus + Stroke/TIA Prior stroke/TIA/thromboembolism + Vascular Vascular disease (MI, PAD, aortic plaque) + Sex Biological sex
Interpretation
Score >=2 males or >=3 females: anticoagulation indicated (prefer DOACs). Score 1 male/2 female: consider anticoagulation. Score 0 male/1 female: no anticoagulation.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Lip GY et al. Refining clinical risk stratification for predicting stroke and thromboembolism in AFLip et al. (CHA2DS2-VASc) 2010 · 2010 · Level I · link last verified 2026-03-23
- ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial FibrillationACC/AHA AF 2023 · 2023 · ACC/AHA/ACCP/HRS · Class I, LOE A · link last verified 2026-03-23
How Scribeable handles it in the note
Scribeable never overwrites a CHA2DS2-VASc Score value that you or the draft state. The inputs are resolved from the transcript and chart and the score is re-computed in code, and when the computed value disagrees with the stated one, the disagreement is shown beside the draft for you to adjudicate.
A comorbidity the chart cannot establish is treated as unknown rather than absent: the computed value is then non-authoritative and you are asked the question instead of the score defaulting to zero.
Classified as a mandatory rule-out score: a missed result carries acute harm, so the activation filter never approves it on uncertainty.
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