Atrial fibrillation (AF), the most common abnormal heart rhythm disorder, is a major cause of stroke in older adults. Oral anticoagulation therapy (OAC) is an effective and widely-available treatment method for reducing the risk of stroke and improving survival rates in patients with AF; however, significant gaps in the appropriate delivery of this therapy exist. This is leaving a large proportion of individuals at risk for stroke and related complications. In a recently published study in JAMA Network Open, researchers sought to determine if OAC prescription led by community pharmacists can improve the delivery of stroke risk reduction therapy in an AF patient population.
The study was undertaken in 27 community pharmacies in Alberta, Canada, and a total of 80 patients (35 men and 45 women) who were 65 years of age or older with known, undertreated, or previously unrecognized AF were identified. Patients were randomized (1:1) into two groups: the early pharmacist intervention group received AF education, blood pressure assessment, and OAC prescription from a pharmacist along with having their primary care physician notified, and the usual care group received AF education, were encouraged to speak with their primary care physician, and their physician was also notified.
At 3-months, the researchers found that guideline-concordant OAC use was 92% in the early pharmacist intervention group and 56% in the usual care group, with an absolute increase of 34%. The findings from this study suggest that an innovative approach involving community pharmacists has the potential to improve existing gaps in OAC delivery. The researchers emphasize that there is still a need for additional larger-scale trials to assess the sustainability of pharmacist-led OAC prescription in the community.
“This collaborative care model, which leverages the expertise of pharmacists, could have far-reaching impact in addressing the large number of people who remain untreated or undertreated for AF and who are at risk of stroke, particularly since several countries have moved toward pharmacist prescribing independently or through collaborative practice agreements,” says lead author Dr. Roopinder Sandhu. “It is important that the infrastructure exists where pharmacists can perform patient assessments; order and interpret labs; initiate, adjust, and monitor drug therapy; access electronic health records; and work in a collaborative care model with physicians.”
This paper was co-authored by the CVC’s Roopinder Sandhu, MD, MPH and Finlay McAlister, MD, MSc, in collaboration with Miriam Fradette, BSc, Pharm; Meng Lin, MSc; Erik Youngson, MMath; Darren Lau, MD; Tammy J. Bungard, BSP, PharmD; and Ross T. Tsuyuki, PharmD, MSc (University of Alberta), and Lisa Dolovich, PharmD, MSc (University of Toronto) and Jeff S. Healey, MD, MSc (McMaster University).
