OBJECTIVES: To analysis the impact of atrial fibrillation (AF) on the annual total direct cost of Ischemic Stroke (IS) patients in Beijing. METHODS: Patients diagnosed with IS were identified from Beijing urban medical insurance database between January 2012- December 2012. 10% of those patients were randomly selected for the study. Their first hospitalization was defined as the index event. And then their medical records including outpatient and inpatient were followed until September 2013. 4,061 IS patients were identified and 922 patients had atrial fibrillation. Demographics, co-morbidities and health resource use were analyzed. The descriptive statistics and Kruskal-Walls test analyses were used. The discount rate was 3.5%. RESULTS: Compared with non-AF patients, 992 IS patients with AF were elder(73.82±11.72 years vs 66.71±14.18 years, p<0.01), had more frequent co-morbidities such as hypertension(39% vs 29%), diabetes mellitus(30% vs 19%), hyperlipidemia(25% vs 19%),  heart failure(10% vs 3%), and coronary heart disease (7% vs 2%)(p<0.05). The average follow-up time for patients with AF and without AF was similar (15.44±5.05 months vs 15.44±4.60 months). In the observational period, 74.21% patients with AF had re-hospitalization, which was more than non-AF patients (44.02%) (p<0.01); and the average hospitalization frequency was 3.96 times for patients with AF and 1.97 times for non-AF patients. The median total length of hospital stay for patients with AF was 49 days (mean 69.04), which was higher non-AF patients (median 21, mean 36.09), (p<0.01). The median annual total cost of IS patients with AF was ¥105,443.60, (mean 167,644.20±212,437.60), which was higher than non-AF patients (median ¥33,303.16, mean 72,558.26±164,669.9) (p<0.01). CONCLUSIONS: IS Patients with AF was elder, and had more frequent co-morbidities than non-AF stroke patients. Those patients were associated with more health resource use including more frequent hospitalization and higher medical cost.