Stroke Prevention in Atrial Fibrillation*

Why is this important?

This module, Stroke Prevention in Atrial Fibrillation, addresses three primary strategies for reducing stroke: (1) diagnosis of atrial fibrillation (AF), (2) AF anticoagulation therapy, and (3) referral of complex AF patients for consultation with a cardiologist or electrophysiologist when it is clear that desired patient outcomes are not being met with prescribed therapy.

  • Stroke is the leading preventable cause of disability in the United States.
  • Stroke risk persists in patients with atrial fibrillation regardless of symptoms and/or rhythm management.
  • Significant gaps exist in treating atrial fibrillation for the prevention of stroke.
  • Anticoagulation can reduce the risk of stroke by 60 to 80 percent.
  • Up to two-thirds of AF patients who had strokes were not prescribed anticoagulants or blood thinners.

How will these tools help?

  • The tools may increase the comfort level of primary care physicians initiating anticoagulation.
  • The tools help clinicians consider anticoagulation sooner in patients who are found to have atrial fibrillation with at least one risk factor for stroke.
  • The tools help clinicians consider referral to cardiologist or electrophysiologist when it is clear that desired patient outcomes (rate, rhythm or symptom control) are not being met with prescribed therapy.


Target Audience

Target Audience

  • Physicians

  • Physician Assistants

  • Nurse Practitioners

  • Registered Nurses

  • Medical Assistants

  • Practice Managers

Learning Objectives

Learning Objectives

  • Recognize atrial fibrillation in patients not yet diagnosed with the disorder, including those with comorbidities such as sleep apnea and thyroid disorders
  • Apply the CHADS2; CHA2DS2-VASC; and HAS-BLED risk scoring systems to determine appropriate anticoagulation therapy based upon individual risk of stroke and bleeding
  • Effectively communicate with patients regarding the pros and cons of different anticoagulation strategies; the risk of stroke and bleeding; and the importance of lifelong adherence to the prescribed therapy
  • Refer appropriate patients to a cardiologist or electrophysiologist for consultation as soon as it is clear that desired patient outcomes for rate or rhythm control, symptom relief or stroke risk reduction are not being met with prescribed therapy.


Grant funding for this module was provided by Bristol-Myers Squibb

Course summary
Available credit: 
  • 20.00 ABIM MOC
  • 20.00 AMA PRA Category 1 Credit™
  • 1.00 Attendance
Course opens: 
Course expires: 
Parent activity set: 

Practice Advisor Content Manager: 

Jillian Schneider, MHA, Manager Practice Support, American College of Physicians


Andrew Dunn, MD, MPH, SFHM, FACP, Professor of Medicine, Chief, Division of Hospital Medicine, Mount Sinai Health System

Marcin Kowalski, MD, MBA, FACC, FHRS, Director of Cardiac Electrophysiology, Associate Director of Cardiology Fellowship Program, Staten Island University Hospital, Northwell Health System

Tara Parham, MSN, AGACNP-BC, Acute Care Nurse Practitioner, Cardiac Electrophysiology, Hospital of the University of Pennsylvania

Staff Editors:

Laura Blum Meisnere, Vice-President, Health Policy, Heart Rhythm Society

Michele Duchin-Watson, Associate, Center for Quality, American College of Physicians

Jillian Nash-Arot, Associate, Center for Patient Partnership in Healthcare, American College of Physicians

Wendy Nickel, MPH, Director Center for Patient Partnership, American College of Physicians

Anne Marie Smith, MBA, Vice-President, Quality Improvement Education, Heart Rhythm Society

Selam Wubu, MPH, Senior Associate, Center for Quality, American College of Physicians



The following have disclosed relationships with commercial companies or organizations:

Andrew Dunn, MD, MPH, SFHM, FACP

Bristol-Myers Squibb, Pfizer

Marcin Kowalski, MD, MBA, FACC, FHRS

Medtronic, St. Jude

All other individuals listed (manager, contributors, editors) have nothing to disclose.

Continuing Medical Education

The American College of Physicians (ACP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians.

The ACP designates this CME activity for a maximum of 20 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 20 practice assessment MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credit claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

This module offers CME and practice assessment MOC points, as well as verification of attendance. Credit is divided into two stages. After taking the ACP Practice Biopsy, reading the background material and case study, and reviewing the resources, users may submit for up to 10 credits and points. To receive the remaining 10 credits and points you must create an Action Plan, implement measurable changes in one or more targeted areas, and come back after 30 days and take a Follow-up Biopsy before CME/MOC can be claimed.

Once you have completed each stage, you will be provided instructions on how to claim CME and MOC credit or download a certificate of attendance.

Original Release Date: 06/29/2017
Rerelease Date: 08/24/2020
Expiration Date: 08/24/2023

To earn CME credits, you must attest after completion of the second module biopsy that you have:

  • Participated in the completion of the ACP Practice Biopsy
  • Participated in the review of the ACP Practice Biopsy result
  • Participated in identifying an action plan to improve our practice
  • Participated in the implementation of the plan
  • Participated in the follow up ACP Practice Biopsy to measure improvement

When you have done so, follow the on-screen instructions to complete and submit the submission form.

Available Credit

  • 20.00 ABIM MOC
  • 20.00 AMA PRA Category 1 Credit™
  • 1.00 Attendance


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