Detecting Atrial Fibrillation in Primary Care: Warning Signs and Modifiable Risk Factors

Many patients with atrial fibrillation (AFib) have no symptoms at all, according to Geoffrey Barnes, MD, which makes a careful physical exam one of the most valuable detection tools primary care physicians have.¹ Barnes, a board-certified cardiologist and vascular medicine specialist at the University of Michigan Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, explains that simply feeling for the pulse and listening to the heartbeat can reveal the irregular rhythm that warrants a closer look. When anything sounds or feels abnormal, he advises ordering an electrocardiogram to determine whether AFib is the cause.

For patients who do present with symptoms, Barnes walks through the complaints clinicians hear most often: palpitations, a sensation that the heart is skipping beats, a racing heartbeat, and episodes of breathlessness.¹

Barnes then turns to prevention, identifying 2 modifiable risk factors that primary care physicians see regularly and are well positioned to manage during routine visits: hypertension and obstructive sleep apnea.² He notes that hypertension sets patients up not only for AFib but for many other cardiovascular diseases, so getting blood pressure under good control pays dividends well beyond heart rhythm.

Sleep apnea, he argues, is one of the biggest stressors on the heart, particularly the left atrium. It is also common, affecting an estimated 21% to 74% of patients with AFib.³ Diagnosing and treating it, whether with a continuous positive airway pressure machine, weight loss, or both, can decrease AFib burden and, in many patients, even prevent the arrhythmia or make it a much less common problem.^2,3

Watch the full video above for Barnes' practical perspective on catching AFib early, including in patients who feel perfectly well, and on addressing the everyday risk factors that fuel it.

Relevant disclosures for Barnes include Pfizer, Bristol-Myers Squibb, Janssen, and Acelis Connected Health.

References:

1. About atrial fibrillation. Centers for Disease Control and Prevention. Published May 14, 2024. Accessed September 28, 2026. https://www.cdc.gov/heart-disease/about/atrial-fibrillation.html
2. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1-e156. doi:10.1161/CIR.0000000000001193
3. Linz D, McEvoy RD, Cowie MR, et al. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. 2018;3:532-540. doi:10.1001/jamacardio.2018.0095