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Background  While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce.    Methods and Results  Olmsted County,  MN  residents with incident atrial fibrillation or atrial flutter (collectively referred to as  AF ) from 2000 to 2010 were identified. Cox regression determined associations of year of  AF  diagnosis with ischemic stroke and transient ischemic attack ( TIA ) occurring through 2013. Among 3247  AF  patients, 321 (10%) had an ischemic stroke/ TIA  over a mean of 4.6 years (incidence rate [95%  CI ] per 100 person‐years: 2.14 [1.91–2.38]). Two hundred thirty‐nine (7%) of 3265  AF  patients experienced an ischemic stroke (incidence rate: 1.54 [1.35–1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95%  CI ] per year of  AF  diagnosis: 1.00 [0.96–1.04] for ischemic stroke/ TIA ; 1.01 [0.96–1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8% at 1 year after  AF  diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95%  CI ] per year of  AF  diagnosis: 1.06 [0.97–1.15] for ischemic stroke/ TIA ; 1.08 [0.98–1.20] for ischemic stroke only).    Conclusions  Strokes/ TIA s are frequent after  AF , occurring in 10% of patients after 5 years of follow‐up. The occurrence of stroke/ TIA  did not decline over the last decade, which may be influenced by a leveling off of anticoagulation use. This concerning trend has major public health implications.

No Decline in the Risk of Stroke Following Incident Atrial Fibrillation Since 2000 in the Community: A Concerning Trend