The primary prevention of cardiovascular disease is a success story in modern medicine.1 Because of the effectiveness of implantable cardioverter-defibrillators in the primary prevention of sudden cardiac death,2,3 there is great interest in developing accurate clinical prediction tools to determine optimal patient selection for implantation of those devices. Because primary prevention lipid-lowering drugs have been shown to reduce mortality, the Framingham risk score is widely used in clinical practice to predict who will benefit most from those drugs.4 In stark contrast, there is no known primary prevention strategy for the most common arrhythmia, atrial fibrillation (AF). So why do we care about predicting new-onset, or incident, AF? In fact, it is precisely because we have no primary prevention strategy that an accurate prediction tool for incident AF is needed. To perform feasible studies of “upstream” therapies for the prevention of AF, we must first be able to identify those at risk.
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