The R2CHADS2 score is a modification of the CHADS2 score that incorporates renal dysfunction as an additional marker. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in North America, Europe and Australia.
Patient selection: nonvalvular atrial fibrillation
Outcome: stroke or systemic embolism
Parameters:
(1) history of stroke or transient ischemic attack (TIA)
(2) creatinine clearance in mL per minute by the Cockcroft and Gault equation
(3) diastolic blood pressure in mm Hg
(4) history of vascular disease
(5) new or persistent atrial fibrillation
(6) heart rate in beats per minute
(7) gender
(8) history of diabetes mellitus
(9) history of hypertension
(10) age in years
(11) evidence of heart failure
|
Parameter |
Finding |
Points |
|
history of stroke or TIA |
no |
0 |
|
|
yes |
18 |
|
creatinine clearance |
<= 40 mL/min |
29 |
|
|
41 to 50 |
26 |
|
|
51 to 60 |
23 |
|
|
61 to 70 |
19 |
|
|
71 to 80 |
16 |
|
|
81 to 90 |
13 |
|
|
91 to 100 |
10 |
|
|
101 to 110 |
6 |
|
|
111 to 120 |
3 |
|
|
> 120 mL/min |
0 |
|
diastolic blood pressure |
<= 70 mm Hg |
0 |
|
|
71 to 80 |
3 |
|
|
81 to 90 |
7 |
|
|
91 to 100 |
10 |
|
|
> 100 mm Hg |
13 |
|
history of vascular disease |
no |
0 |
|
|
yes |
6 |
|
new or persistent AF |
no |
0 |
|
|
yes |
8 |
|
heart rate |
<= 70 beats per minute |
0 |
|
|
71 to 80 |
2 |
|
|
81 to 90 |
3 |
|
|
91 to 100 |
5 |
|
|
> 100 |
7 |
|
gender |
male |
0 |
|
|
female |
5 |
|
diabetes |
no |
0 |
|
|
yes |
4 |
|
hypertension |
no |
0 |
|
|
yes |
5 |
|
age in years |
<= 65 years |
0 |
|
|
66 to 75 years |
2 |
|
|
> 75 years |
3 |
|
heart failure |
no |
2 |
|
|
yes |
0 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the greater the risk of a poor outcome.
|
Score |
2-Year Risk of Stroke or Emboli |
|
0 to 60 |
(0.001199 * ((score)^2)) + (0.002797 * (score)) + 0.8.176 |
|
60 to 100 |
(0.0051 * ((score)^2)) - (0.4753 * (score)) + 15.62 |
Performance:
• The area under the ROC curve was 0.64 and performed better than CHADS2 or CHA2DS2VASc.
Specialty: Neurology
