FOR APPs & PRIMARY CARE CLINICIANS
Atrial fibrillation — Quick reference
First steps, urgent findings, referral guidance, and handoff essentials.
First steps
Assess symptoms, hemodynamic status, ventricular rate, and stroke risk. Obtain an EKG and review medications, adherence, and reversible contributors. Calculate CHA2DS2-VASc: OAC is recommended at ≥2 in men or ≥3 in women, unless contraindicated. At 1 in men or 2 in women, consider OAC after individualized discussion.
Recognize the urgent patient
Instability, ischemic symptoms, severe dyspnea, or truly significant symptoms with RVR require acute assessment/EMS.
When to refer
Refer to EP for rhythm-control assessment and discussion of early treatment. Stroke protection and rate control remain separate decisions.
What to send with the referral
EKGs; AF pattern/onset and symptoms; stroke-risk assessment; anticoagulant and rate-control doses; relevant labs and prior treatments.
Avoid this pitfall
A controlled rate or apparent sinus rhythm does not independently remove an anticoagulation indication.
Reviewed October 11, 2026. This quick reference summarizes the linked guide; use the full guide for context and clinical references.