AFib management in primary care: anticoagulation choices and rate/rhythm options

[Aaron_S]

I'm a newly practicing family physician, and I've inherited a panel of patients with atrial fibrillation, many of whom are on older anticoagulants or have unclear stroke risk stratification. I want to ensure my approach to atrial fibrillation management is up-to-date, balancing stroke prevention with bleeding risk, especially for elderly patients with multiple comorbidities. For more experienced clinicians, what decision-support tools or guidelines do you find most practical in the primary care setting for initiating and monitoring anticoagulation? How do you navigate conversations about switching from warfarin to a DOAC, and what's your protocol for assessing and managing bleeding risk over time? Additionally, beyond anticoagulation, how actively do you pursue rate versus rhythm control strategies, and when do you typically refer to cardiology for ablation or more advanced management?