Improving Stroke Prevention in Atrial Fibrillation Through Pharmacist Prescribing

Inclusion Criteria: * Age ≥ 65 years with one additional stroke risk factor (hypertension, diabetes, heart failure history of or left ventricular ejection fraction \<0.40), previous stroke or transient ischemic attack). * Atrial fibrillation and not on oral anticoagulation (OAC) therapy but eligible * Atrial fibrillation on sub-optimal OAC Exclusion Criteria: * Uncontrolled hypertension (defined as average SBP ≥ 160 mmHg \[2 readings taken at time of screening\]). * End stage renal disease (CrCl \< 15 ml/min) * Valvular Heart Disease including those with prosthetic valve, mitral stenosis (moderate to severe) or valve repair. * Excess alcohol intake (males: ≥ 28 units/week, females: ≥ 21 units/week. One unit of alcohol = 8 oz beer, 1 oz hard liquor or 4 oz wine). * Intracranial bleed at any point. * History of "Major Bleeding" at any point (defined as overt bleeding at a critical site including intracranial, intraspinal, intraocular, pericardial, or retroperitoneal; or bleed requiring hospitalization). * Foreshortened life-expectancy or severe comorbidities precluding study follow-up period * Unable to read/understand English * Severe cognitive impairment (defined as score ≥ 5 on the Short Portable Mental Status Questionnaire)