Pharmacists help lower stroke risk in patients with undiagnosed, undertreated AFib
Asking pharmacists to play a more active role in patient care can help patients with undiagnosed and undertreated atrial fibrillation (AFib) receive the care they need, according to a new study published in JAMA Network Open.[1]
“Despite accessible clinical guidelines for identifying individuals with AFib who stand to benefit from oral anticoagulation (OAC), major gaps in the delivery of appropriate OAC therapy persist, leaving a large proportion of persons with AFib unnecessarily at risk for stroke and its sequalae.,” wrote first author Roopinder K. Sandhu, MD, MPH, with the University of Calgary’s Libin Cardiovascular Institute, and colleagues. Recent advances in OAC therapeutics offer effective drug choices that are safer and more easily administered and managed than warfarin, yet large proportions of the population at risk for AFib remain undertreated or untreated.”
Sandhu et al. tested the effectiveness of a new health intervention that put pharmacists in the driver’s seat, prescribing OAC medications to high-risk patients with either known AFib that is not properly being treated or undiagnosed AFib. Patients with undiagnosed AFib were identified by performing 30-second readings with a single-lead electrocardiogram device with a built-in AFib detector. This intervention was put into place at 27 different community pharmacies in Canada.
Overall, 80 different patients 65 years old or older were enrolled in the team’s study. The mean age was 79.7 years old, and 56.3% of patients were women. The median CHADS2 score was 2. While 39 patients were included in the early pharmacist intervention group, the other 41 patients were treated with usual care.
After three months, the team found that guideline-recommended OAC use was seen in 92.3% of patients from the early intervention group and 56.1% of patients from the control group. Primary care providers turned to pharmacists for prescribing advice when treating 26.1% of patients from the early intervention group.
Researchers also explored clinical outcomes, noting that there was “no significant difference” between the two groups when it came to emergency department visits or hospitalizations.
“To the best of our knowledge, this randomized clinical trial is the first to demonstrate feasibility and efficacy of a pharmacist-led intervention to optimize OAC prescription for stroke risk reduction in patients with actionable AFib presenting to community pharmacies,” the author wrote. “Patients in the pharmacist intervention group reported high satisfaction with pharmacists’ services.”
The group described pharmacies as an “attractive setting for community-based AFib screening” and “an ideal setting for addressing care gaps in OAC delivery.” In addition, they said, pharmacies may be “especially beneficial in underserved communities.”
Sandhu and colleagues did emphasize that larger trials are still needed to confirm the safety and effectiveness of this approach.
Read the full study in JAMA Network Open here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.