Ischemic stroke as the initial manifestation of atrial fibrillation; is it higher than expected?

[...]patients with asymptomatic AF often refuse treatment and as a result are at increased risk of thromboembolic events, especially ischemic stroke.1 The Framingham Heart Study, a comprehensive large cohort community-based study of 1 809 patients with AF heart rhythm, estimated that 2 to 5 ischemic strokes per 10 000 person-years were the first sign of AF heart rhythm.2 To assess the burden of ischemic stroke as an initial manifestation of AF, we did a prospective study. Furthermore, due to very crowded private physician offices, there is not enough time for patient education and this results in another problem: some patients with a diagnosis of AF undergo a course of treatment with anticoagulants, but due to the lack of knowledge about the importance of their disease and the need for treatment over time, these patients do not visit their physician again and anticoagulation treatment then stops. To decrease this burden, several strategies are recommended, including population-wide AF-screening efforts, pulse check education for patients and their families,3 spending more time on education in physician offices providing complete and detailed explanations about AF and its risks, informing patients about medication, side effects of taking and not taking it, and importantly, continuous follow-up of the patients.4-6 At the bottom line, the burden of ischemic stroke as the initial manifestation of AF seems to be higher in our region; thus, physicians should be alerted and appropriate interventions should be applied.