Fog on the Crystal Ball? Missing Atrial Fibrillation in Forecasting the Future of Stroke

The policy statement by the American Heart Association and American Stroke Association1 on the future of stroke highlights not only the increasing costs of stroke but also, importantly, what might be done to reduce that burden. It makes an important contribution on many aspects of stroke. However, we found it most surprising that in an article that forecasts stroke, atrial fibrillation (AF) was mentioned only twice and was not listed as a risk factor for stroke. This is despite evidence that AF causes ≥25% of ischemic strokes,2 probably a gross underestimate, given the mounting evidence, suggesting that a large proportion of cryptogenic stroke is attributable to AF.3 Furthermore, recent work suggests that stroke incidence is in fact declining, but the proportion caused by AF …