A 72-year-old woman is found to have atrial fibrillation on a routine ECG. She has hypertension and type 2 diabetes mellitus but no history of stroke or TIA. She has no heart failure and her echocardiogram shows preserved systolic function. According to the CHA₂DS₂-VASc score, what is her score and what is the appropriate management?

• A Score 2; aspirin alone is sufficient
• B Score 1; no antithrombotic therapy needed
• C Score 4; oral anticoagulation with a DOAC is recommended ✓
• D Score 3; rate control only is adequate

Explanation

CHA₂DS₂-VASc assigns 1 point each for congestive heart failure, hypertension, age 65–74, diabetes, vascular disease, and female sex; and 2 points for age ≥ 75 and prior stroke/TIA. This patient scores: hypertension (1) + diabetes (1) + age 72 (1) + female sex (1) = 4. A score ≥ 2 in women (≥ 1 in men after excluding sex) warrants anticoagulation; DOACs are preferred over warfarin for non-valvular AF. Aspirin alone is no longer recommended for stroke prevention in AF as its benefit is minimal and bleeding risk is comparable. Rate control does not address thromboembolic risk.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.