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Letter regarding article by Gage et al, "selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin".

To the Editor:

The use of meta-analysis to refine stroke risk stratification in atrial fibrillation has enabled the separation of the stroke incidences in patients with pure arrhythmic syndromes from patients with ≥1 additional significant cardiovascular comorbidities. Accordingly, the new report by Gage et al1 reiterates that patients with nonvalvular atrial fibrillation designated “low risk” by virtue of the absence of any major cardiovascular comorbidities exhibit very low stroke incidence. Stroke incidence in the “low-risk” subgroups defined by several methods ranged from 0.5 to 1.4 events per 100 patient-years, which closely parallels the findings of previous independent patient-level meta-analyses from the same authors. Importantly, this range of stroke incidence is comparable to but not higher than the normal baseline stroke incidence of age- and sex-matched standard populations.2 What the authors have not …