In this issue of Stroke, Dr. Hayden and colleagues report on 5-year outcomes and secondary prevention utilization rates after atrial fibrillation – related strokes (AF-strokes) from North Dublin city.

AF-strokes are associated with greater severity and poor outcomes; however, the authors, in light of the increasing prevalence of atrial fibrillation (AF), seek to report population-level long-term outcomes of AF-strokes.

The data are derived from the Northern Dublin Population Stroke study, a prospective cohort of TIA and stroke patients established in 2006. Only stroke patients with a diagnosis of AF prior to the index stroke or an AF diagnosis within 3 months of the stroke were included in this study. Their outcomes were: 5-year survival, stroke recurrence, disability (by mRS), and nursing home residence in addition to prescription rates for secondary prevention anti-thrombotic medications.

They identified 177 patients with AF-stroke with a mean age of 76.5 and median CHA2DS2-VASc score of 6. Survival data was complete for nearly all patients. For survivors, outcome data was available for at least 90% for each outcome.

Key findings at 5 years:
· Only 39.2% of ischemic AF-stroke survivors were alive. Statin and warfarin prescription were protective.
· Only 14% were alive and independent.
· 21.5% had recurrent stroke.
· 25.9% had required nursing home residence at some time.
· In those surviving at least 28 days, 54.5% were prescribed an anti-platelet alone and 36% received an oral anticoagulant medication.
· Statins were prescribed in 74.1% of patients.

The findings of this study vitally underscore the morbidity and mortality associated with AF and AF-stroke. Additionally, this study confirms the widespread under-utilization of effective secondary prevention measures in this high risk population. The data are increasingly compelling; AF-related stroke prevention is crucial. The time is right to begin uniformly and systematically applying existing therapies.