A systematic review of stroke risk factors found that prior stroke or transient ischemic attack (TIA) (15 of 16 studies positive; RR, 2.86), hypertension (11 of 20 studies positive; RR, 2.27), aging (9 of 13 studies positive; RR, 1.46 per decade increase), structural heart disease (9 of 13 studies positive; RR, 2.0), and diabetes (9 of 14 studies positive; RR, 1.62) were independent predictors of stroke. Supportive evidence was found for sex (8 of 22 studies positive; RR, 1.67), vascular disease studies positive; RR, 1.85).42 Nonparoxysmal AF is associated with a highly signi cant increase in thromboembolism (multivariable adjusted hazard ratio In individuals with HF, AF is associated with worse prognosis than sinus rhythm.44,45 HF is an independent predictor of stroke/thromboembolism, mortality, and other clinical outcomes in individuals with AF, compared with no HF.46 Moreover, HF is a predictor of development of AF and has been incorporated in tools for risk prediction of incident AF.47 All-cause mortality is higher in AF patients with HF with reduced ejection fraction compared with HF with preserved ejection although stroke risk (RR, 0.85; 95% CI, 0.70-1.03; P .094) and HF hospitalization (RR, 1.21; 95% CI, 0.96-1.53; P .115) are not signi cantly different.48 CKD is an independent predictor of risk of stroke/ thromboembolism. AF patients with an estimated glomerular ltration rate < 60 mL/min compared with those with an estimated glomerular ltration rate $ 60 mL/min have increased risk of stroke/ P < .001), with a 0.41% (0.17%-0.65%) annual increase in rate for a 10 mL/min decrease in renal function.49 The risk is higher in individuals requiring renal replacement therapy (HR, 1.83; 95% CI, 1.57-2.14; P < .001). 