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Risk stratification using validated scoring systems is fundamental to contemporary cardiovascular medicine, underpinning diagnosis, treatment selection, and prognostic assessment. This review provides a comprehensive overview of the major risk scores used across a broad spectrum of cardiovascular diseases, such as atrial fibrillation, acute coronary syndrome, and others, highlighting their development, clinical applications, and evolving roles in guideline-directed care. Importantly, predictive performance alone does not guarantee clinical benefit. We therefore examine evidence from randomized implementation trials evaluating whether risk score-guided management improves clinical outcomes and discuss the future role of artificial intelligence in reshaping cardiovascular risk assessment by integrating dynamic, individualized prediction with actionable clinical decision support.