SEE PAGE 1573 A mong our fears, stroke is high. Although stroke is often termed a cerebrovascular accident, when due to atrial fibrillation (AF), it should not be considered “accidental,” as it is preventable with adequate anticoagulation therapy. As such, oral anticoagulation (OAC) is perhaps the most important therapeutic intervention in AF. As life expectancy has increased and as the care and survival of patients with cardiovascular disorders has improved, AF incidence has also increased and will continue to do so (1); so too, will stroke risk, as risk factors for stroke are many of the same factors that promote AF itself (1). Given these realities, we must improve our ability to identify patients at risk for AF and stroke as well as improve our options for and use of OAC. Better identification of AF patients at high stroke risk has involved both widening the nature and use of risk definers, as with the shift from CHADS2 (congestive heart failure, hypertension, age $75 years, diabetes mellitus, prior stroke, transient ischemic attack [TIA] or thromboembolism) to CHA2DS2-VASc (congestive heart failure, hypertension, age $75 years, diabetes mellitus, prior stroke, TIA or thromboembolism, vascular disease, age 65–74 years, sex category [female]) (with perhaps renal function, biomarkers, and echocardiographic parameters still to be added or accepted), as well as increasing AF detection. The latter has taken us from recognizing AF either during evaluation of symptoms or its coincidental occurrence during

中文翻译：

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药丸在瓶子里永远不起作用*

见第 1573 页 我们的恐惧之一是中风。虽然中风通常被称为脑血管意外，但当由于心房颤动 (AF) 时，不应将其视为“意外”，因为它可以通过适当的抗凝治疗来预防。因此，口服抗凝剂 (OAC) 可能是 AF 中最重要的治疗干预措施。随着预期寿命的延长以及心血管疾病患者的护理和生存率的提高，房颤发病率也有所增加，并将继续增加 (1)；中风风险也是如此，因为中风的风险因素与促进 AF 本身的许多因素相同 (1)。鉴于这些现实，我们必须提高识别有 AF 和中风风险的患者的能力，并改进我们对 OAC 的选择和使用。更好地识别具有高卒中风险的 AF 患者涉及扩大风险定义器的性质和使用，如从 CHADS2（充血性心力衰竭、高血压、75 岁、糖尿病、既往卒中、短暂性脑缺血发作 [TIA]）转变或血栓栓塞）至 CHA2DS2-VASc（充血性心力衰竭、高血压、年龄 75 美元、糖尿病、既往中风、TIA 或血栓栓塞、血管疾病、年龄 65-74 岁、性别类别 [女性]）（可能有肾功能、生物标志物，还有待添加或接受的超声心动图参数），以及增加 AF 检测。后者使我们无法在评估症状期间或在评估期间偶然发生 AF 75 岁，糖尿病，既往中风，短暂性脑缺血发作 [TIA] 或血栓栓塞）至 CHA2DS2-VASc（充血性心力衰竭，高血压，75 岁，糖尿病，既往中风，TIA 或血栓栓塞，血管疾病，65 岁至74 岁，性别类别 [女性]）（可能还有肾功能、生物标志物和超声心动图参数尚待添加或接受），以及增加 AF 检测。后者使我们无法在评估症状期间或在评估期间偶然发生 AF 75 岁，糖尿病，既往中风，短暂性脑缺血发作 [TIA] 或血栓栓塞）至 CHA2DS2-VASc（充血性心力衰竭，高血压，75 岁，糖尿病，既往中风，TIA 或血栓栓塞，血管疾病，65 岁至74 岁，性别类别 [女性]）（可能还有肾功能、生物标志物和超声心动图参数尚待添加或接受），以及增加 AF 检测。后者使我们无法在评估症状期间或在评估期间偶然发生 AF 性别类别 [女性]）（可能还有肾功能、生物标志物和超声心动图参数尚待添加或接受），以及增加 AF 检测。后者使我们无法在评估症状期间或在评估期间偶然发生 AF 性别类别 [女性]）（可能还有肾功能、生物标志物和超声心动图参数尚待添加或接受），以及增加 AF 检测。后者使我们无法在评估症状期间或在评估期间偶然发生 AF