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)