This editorial refers to ‘Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation’†, by L. Friberg et al. on page 967
Atrial fibrillation (AF) is accompanied by substantial morbidity1 and is increasing in both incidence and prevalence.2,3 Stroke is the chief hazard from AF, and is five times more likely among individuals with AF than among those without the condition.4 Moreover, AF-related strokes are associated with an ∼50% increased odds of disability and a 60% increased odds of death at 3 months compared with strokes of other aetiologies.5 The need for effective therapies that reduce morbidity from AF is underscored by the presence of an increasingly ageing population, particularly because the elderly are at increased risk for AF-related complications such as stroke.6
Although several stroke risk stratification schemes exist, which facilitate personalized thrombo-embolism prophylaxis for individuals with AF,1 the underprescription of thrombo-embolism prophylaxis represents an established barrier to care.7–9 The current AF classification scheme endorsed by the American College of Cardiology, American Heart Association, and European Society of Cardiology does not explicitly take stroke risk into account.1 Rather, the AF classification scheme emphasizes rhythm-based patterns of disease. AF is classified as paroxysmal if it self-terminates within 1 week, persistent if it continues beyond this period and is not self-terminating, or permanent if attempts to terminate the rhythm fail or no attempts are made.
Friberg et al. have now attempted to discern whether the incidence of stroke in AF differs according to AF pattern.10 The investigators performed a retrospective, observational analysis among patients diagnosed with AF at a single hospital or primary …