One Question PCPs Should Ask Every Patient with Atrial Fibrillation

If primary care clinicians make one change to reduce stroke in patients with atrial fibrillation (AF), Geoffrey Barnes, MD, says it should be this: ask every patient whether they are using a stroke-preventive medication. The gap is substantial; in one large US registry, fewer than half of high-risk outpatients with AF were prescribed an oral anticoagulant.¹

Barnes, a cardiologist and vascular medicine specialist at the University of Michigan Frankel Cardiovascular Center, encourages clinicians to work with patients who are not on stroke prevention to put a strategy in place, whether an oral anticoagulant, a left atrial appendage occlusion device, or another approach. The conversation can start as simply as asking, "Are you taking your medication?" and, if not, "What can we do to help you so that you don't experience a stroke?"

Barnes also looks ahead to the development in AF care he is most excited about: an emerging class of anticoagulants that he believes could help prevent stroke with substantially less bleeding than current options. In the phase 2 AZALEA-TIMI 71 trial, for example, abelacimab was associated with markedly lower bleeding rates than rivaroxaban.²

“Despite important advances in stroke prevention, too many patients remain without optimal protection because clinicians and patients must continue to weigh the risk of a devastating blood clot against the risk of bleeding. Factor XIa inhibition represents an important area of research because it is exploring whether we can prevent harmful clot formation while preserving normal clotting,” Barnes told Patient Care Online.

“Large Phase 3 studies are evaluating this approach, and the results have the potential to provide us an important new tool to protect a broader range of patients in the future,” Barnes added.

Watch the full episode above to hear Barnes' call to action for primary care and his outlook on the next generation of AF therapy.

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

For more of our conversation with Barnes, check out:

• Detecting Atrial Fibrillation in Primary Care: Warning Signs and Modifiable Risk Factors
• Atrial Fibrillation Stroke Prevention: Expert Guidance for Primary Care Physicians

References:

1. Hsu JC, Maddox TM, Kennedy KF, et al. Oral anticoagulant therapy prescription in patients with atrial fibrillation across the spectrum of stroke risk: insights from the NCDR PINNACLE Registry. JAMA Cardiol. 2016;1:55-62. doi:10.1001/jamacardio.2015.0374

2. Ruff CT, Patel SM, Giugliano RP, et al. Abelacimab versus rivaroxaban in patients with atrial fibrillation. N Engl J Med. 2025;392:361-371. doi:10.1056/NEJMoa2406674