CHA₂DS₂-VA Score for AF (ESC 2024)
2024 ESC atrial fibrillation guideline stroke-risk score: CHA₂DS₂-VASc without the sex category. Oral anticoagulation is recommended at a score of 2 or more and should be considered at a score of 1.
Score interpretation
No CHA₂DS₂-VA risk factor.
→ Oral anticoagulation is not indicated on the score alone; reassess risk factors regularly.
ESC 2024: oral anticoagulation should be considered (Class IIa).
→ Shared decision on anticoagulation; address modifiable bleeding risk factors.
ESC 2024: oral anticoagulation is recommended (Class I).
→ Offer a DOAC in preference to a VKA (VKA for mechanical valves or moderate–severe mitral stenosis); assess and address bleeding risk.
Interpretation bands for the CHA₂DS₂-VA. Apply clinical judgement and local guidance.
References
- Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024;45(36):3314–3414.
Related
Curated clinical cross-links plus same-class fallbacks.
- CHA₂DS₂-VASc Score · Atrial Fibrillation
- ORBIT Bleeding Risk Score for AF · Atrial Fibrillation
- CHADS-65 for Atrial Fibrillation · Atrial Fibrillation
- GARFIELD-AF Risk Score for Atrial Fibrillation · Atrial Fibrillation
- CHADS-65 Score for Atrial Fibrillation · Atrial Fibrillation
- CHARGE-AF Score for Incident Atrial Fibrillation · Atrial Fibrillation
- Bivalirudin (PCI Anticoagulation) · Direct Thrombin Inhibitor / PCI
- Vernakalant · Atrial-selective antiarrhythmic
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Bivalirudin · Anticoagulation
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The CHA₂DS₂-VA is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.