• Routinely in the clinical assessment and follow-up of patients with Atrial Fibrillation
• To guide the decision between a rate-control vs. rhythm-control (cardioversion, antiarrhythmics, ablation) strategy

The original EHRA score had 4 classes. It was modified by the European Heart Rhythm Association to split Class II into IIa and IIb based on whether symptoms "trouble" the patient. This split is clinically vital because it represents the exact threshold where European and American guidelines recommend considering rhythm control therapies.

• Class I: Asymptomatic AF. Pure rate control is usually sufficient unless tachycardia-induced cardiomyopathy develops.
• Class IIa: Mild symptoms. Typically managed with rate control.
• Class IIb: Troubling symptoms. Strong indication to consider restoration of sinus rhythm.
• Class III/IV: Severe/Disabling. Definite indication for rhythm control (ablation or AADs).

EHRA scores can fluctuate based on ventricular rate. Always assess the EHRA score when the patient is in AF, and document whether their rate was controlled at the time of assessment.