Rather than focus on identifying high risk, the focus should be on initially identifying low risk patients. A low risk categorization by the CHA2DS2-VASc (0 in males and 1 in females) consistently identi es low risk patients, with event rates around 1% per year or under, notwithstanding the possible need to re-categorize the age 65 to 74 years criterion in Asians.65 The majority of published studies and systematic reviews suggest that the CHA2DS2-VASc score is generally better than CHADS2, Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), and CHADS2 score plus age 65-74 years, used in Canadian guidelines (CHADS65) in identifying low risk patients, although the proportion of the population assigned as low risk is small. However, there are con icting data in different cohorts for performance of the ATRIA score (United Kingdom Clinical Practice Research Datalink [UK CPRD] and Swedish cohorts vs Danish and Taiwan cohorts). Differences between the ATRIA and CHA2DS2-VASc disappear when cut-points are optimized for stroke risk of the cohort. There are discrepancies between individual studies on the relative performance of ATRIA and CHA2DS2-VASc scores in identifying low risk patients, but the CHA2DS2-VASc score is easier to calculate. Rather than using risk scores in a categorical manner recognizing the various limitations of scores to predict high risk patients who sustain events and given that for each risk strata or given risk score point, we recognized there is wide variation in reported event rates based on reported study clinical setting, patient population, ethnicity, etc. Notwithstanding that the default should be stroke prevention for all AF patients unless deemed to be low risk, the focus should be to use scores to initially identify low risk patients who do not need antithrombotic therapy, rather than focus on identi cation of high risk patients. 