Atrial Fibrillation: The Epidemic of the New Millennium

• Atrial fibrillation
• Cerebrovascular disorders
• Anticoagulants
• Hemorrhage
• Age factors

By the year 2030, the number of Americans older than 65 years of age will double. Approximately 4% of persons 65 years of age will have atrial fibrillation, and this percentage will increase to approximately 15% at age 75 (1, 2). These data have important implications for the health care system. Most of this growing population of patients will need a simple, cost-effective treatment strategy that can be managed in a primary care setting.

In this issue, Hart and colleagues (3) review stroke prevention trials in patients with atrial fibrillation and confirm the well-described, consistent benefit of warfarin over both aspirin and placebo. They correctly emphasize that this benefit is not offset by the risk for major hemorrhage. They fail to emphasize, however, that atrial fibrillation is a highly heterogeneous disease with respect to risk for stroke. The major benefit of warfarin is seen in patients who are …