Modified EHRA Symptom Scale (Atrial Fibrillation)
The MODIFIED EHRA SYMPTOM SCALE for atrial fibrillation (Wynn and colleagues, Europace 2014; adopted in the 2020 ESC AF guideline).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Whether atrial fibrillation causes any symptoms
- Yes
- Effect on normal daily activity
- Normal daily activity NOT affected
- Whether the patient is TROUBLED by the symptoms
- Yes
Result: Class 2b
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Ladder
- 1, 2a, 2b, 3, 4. THERE IS NO CLASS 2 - handle as a string, never an integer.
- Class 1
- AF does not cause any symptoms.
- Class 2a
- Daily activity not affected, patient NOT troubled by symptoms.
- Class 2b
- Daily activity not affected, patient IS troubled. The only subjective boundary on the scale.
- Class 3
- Normal daily activity affected.
- Class 4
- Normal daily activity discontinued.
- Symptoms
- The six domains (palpitations, fatigue, dizziness, dyspnea, chest pain, anxiety) are NOT inputs.
- Assessor
- Physician-assessed, not patient-reported. The guideline notes the two frequently diverge.
- Scope
- Says NOTHING about stroke risk. A class 1 patient can have a high CHA2DS2-VASc.
What you enter
- Whether atrial fibrillation causes any symptoms.
- Effect on normal daily activity.
- Whether the patient is TROUBLED by the symptoms.
Full field descriptions
- Whether atrial fibrillation causes any symptoms. NO gives class 1 outright.
- Effect on normal daily activity. The discriminator everywhere except the 2a/2b boundary [not-affected = Normal daily activity NOT affected; affected = Normal daily activity affected; discontinued = Normal daily activity discontinued]
- Whether the patient is TROUBLED by the symptoms. Read ONLY when daily activity is not affected: it is the entire 2a versus 2b split, and the one place this scale turns on a subjective judgment.
How this is calculated
Wynn GJ, Todd DM, Webber M, et al. The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification. Europace. 2014;16(7):965-972. Adopted in Hindricks G, et al. Eur Heart J. 2021;42(5):373-498, Table 6. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.