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What is Your Risk of Having a Stroke With AFIB? The CHADSVASC Score

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Maxed out gauge representing a high stroke risk

Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by irregular heartbeats, which increases the risk of stroke. 

The CHADSVASC score is a clinical prediction tool used to assess the risk of stroke in AF patients.

This score consists of various clinical variables that are assigned points based on their association with stroke risk in AF patients. Let’s explore each component:

  • Congestive Heart Failure (CHF) (1 point): CHF is a condition where the heart cannot efficiently pump blood, leading to fluid buildup in the lungs and other organs. AF patients with CHF are at a higher risk of stroke.
  • Hypertension (1 point): High blood pressure is a significant risk factor for stroke in AF patients. Uncontrolled hypertension increases the strain on the heart and blood vessels, contributing to the formation of blood clots.
  • Age (≥75 years) (2 points) and Age (65-74 years) (1 point): Advanced age is associated with an increased risk of stroke. The score accounts for this by assigning higher points to older individuals.
  • Diabetes Mellitus (1 point): Diabetes is a metabolic disorder that affects the body’s ability to regulate blood sugar levels. AF patients with diabetes have an elevated risk of stroke due to the adverse effects of long-term hyperglycemia.
  • Stroke or Transient Ischemic Attack (TIA) (2 points): A history of stroke or TIA significantly raises the risk of subsequent strokes in AF patients. The previous occurrence of a cerebrovascular event highlights the vulnerability of the patient.
  • Vascular Disease (1 point): The presence of vascular disease, such as peripheral artery disease, coronary artery disease, or aortic plaque, further increases the risk of stroke in AF patients.
  • Sex Category (Female) (1 point): Although females have a lower baseline risk of stroke compared to males, their risk increases in the presence of other risk factors. The score considers this gender-based difference.

Clinical Significance and Stroke Risk Stratification:

Now we can discuss what your total score means. I will offer the conventional or “mainstream” view and also offer my viewpoint. My viewpoint is based on making the person with AF the healthiest version of themselves through our method of Eat Well, Live Well, Think Well. Then we Test, Don’t Guess and use evidence-based supplements and biohacking strategies. 

  • CHA2DS2-VASc score of 0: Low risk (annual stroke rate <1%): Anticoagulation therapy may not be necessary for patients with no risk factors. I still see some patients with a score of O, yet they were recommended pharmaceutical anticoagulants like Eliquis, Xarelto and Pradaxa. I think this is a mistake. There is a much better way to lower stroke risk. 
  • CHA2DS2-VASc score of 1: Moderate risk (annual stroke rate ~1%): According to mainstream cardiologists, anticoagulation therapy should be considered based on individual patient characteristics. Personally, I do not anticoagulate for a score of 1, given the low annual stroke risk. Again, follow our method. 
  • CHA2DS2-VASc score ≥2: High risk (annual stroke rate >2%): Anticoagulation therapy is generally recommended for patients with two or more risk factors. This is debatable as well, especially for people with a score of 2. 

The goal is not to cut stroke risk from 3% to 1.3%. The goal is to cut stroke risk to close to zero percent. Mainstream does not offer that. I think we do. 

Let me be clear. I am not against pharma anticoagulation. There is a time and place. But doctors can do so much better than a quick prescription. 

Clinical Guidelines and Limitations:

The CHA2DS2-VASc score has been endorsed by several professional societies and incorporated into clinical guidelines for stroke prevention in AF patients. However, it is important to recognize the limitations of any risk assessment tool. The CHA2DS2-VASc score does not capture all potential stroke risk factors, such as lifestyle factors (e.g., obesity, smoking) or genetic predisposition.


The CHA2DS2-VASc score is a valuable clinical tool for assessing the risk of stroke in patients with atrial fibrillation. By considering a range of risk factors, it provides a more comprehensive evaluation of stroke risk and aids in determining the need for anticoagulation therapy. However, it is crucial to interpret the score in the context of each patient’s individual characteristics and consider other relevant factors. 

If you have concerns about AF stroke risk, let’s talk. Schedule your free call HERE

Also, PLEASE upgrade your AFIB knowledge by taking our online AFIB course. Click HERE for more information


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He heals the body, instead of just treating the symptoms!

With his professional qualifications as a certified family nurse practitioner, a doctor of chiropractic, and a fellow of the International Academy of Medical Acupuncture, Dr. Smigiel offers patients comprehensive care from a broad perspective of conventional and alternative medicine. He also has extensive experience in functional rehabilitation and chronic pain management.

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About Dr. James Kneller, M.D., Ph.D., FHRS

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Dr. James Kneller is one of the nation’s leading heart rhythm specialists. Dr. Kneller is certified by the American Board of Internal Medicine (ABIM) in Clinical Cardiac Electrophysiology, Cardiovascular Disease, and Internal Medicine.

As a Fellow of the Heart Rhythm Society (FHRS) and Certified Cardiac Device Specialist (CCDS), Kneller provides comprehensive patient care, combining best medical practice with invasive procedures using state-of-the-art technologies to treat heart rhythm disorders.

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About Dr. Lauren Lattanza NMD, FACC

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As a Naturopathic Physician, I am trained to treat the whole person and get to the root cause of disease.

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About Dr. Jack Wolfson DO, FACC

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Dr. Jack Wolfson is a board-certified cardiologist, Amazon best-selling author, husband, father, and the nation’s #1 Natural Heart Doctor.

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Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

Click here for  Natural Heart Doctor Health Coach.

Alternatively, you can email health@naturalheartdoctor.com. A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

Is my medical and payment information secure?

Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.