Atrial fibrillation (AF) is the most common cardiac rhythm disorder1 and one of the most important risk factors for stroke, particularly in the elderly. Stroke-related AF is associated with significant morbidity, mortality and healthcare costs.2 Although we have abundant evidence from randomised trials that anticoagulation, and to a lesser extent antiplatelet therapy, is highly efficacious in preventing stroke in patients with AF, these therapies remain underused, especially in older patients. With an ageing population and an AF prevalence that is rapidly rising,1 a better understanding of the stroke prevention practices in real-world settings is critically important to implement preventive strategies that will improve the outcomes and reduce healthcare costs.

Cowan et al3 report the results of their investigation on the use of stroke prevention therapy for management of AF among 1857 primary-care practices across England from July 2009 to March 2012. Using the Guidance on Risk Assessment and Stroke Prevention in AF (GRASP-AF) tool, they identified 231 833 patients with AF (1.76% of the total population studied) and characterised their risk profiles and antithrombotic therapies. The GRASP-AF tool is valuable for gathering patient data at the primary-care level, and this is a particular …