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Heart failure not stroke is the most common complication of atrial fibrillation Atrial fibrillation is a major public health problem affecting 37 million people worldwide,1 and conferring an increased risk of stroke, heart failure, myocardial infarction, and death, as well as quantifiable impairment in quality of life.2 In the English National Health Service (NHS) alone more new cases of atrial fibrillation are diagnosed each year than the four most common causes of cancer combined,3 and direct expenditure on atrial fibrillation has reached £2.5 billion (€2.9 billion, $3.2 billion).4 The lifetime risk of atrial fibrillation has been estimated,56 but whether this has changed over the past two decades is unknown. Furthermore, the comparative risks of later sequelae for individuals with atrial fibrillation, and whether trends are temporal, has yet to be reported. The linked paper by Vinter and colleagues(doi:10.1136/bmj-2023-077209) addresses these important knowledge gaps in a natio

Ramesh nadarajahJianhua wuEnglish national health service