Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing: A Randomized Clinical Trial.

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Major gaps exist in providing oral anticoagulation therapy (OAC) to patients with atrial fibrillation (AF).
• This deficiency leaves many AF patients at unnecessary risk of stroke and related complications.

Purpose of the Study:

• To evaluate if pharmacist-led OAC prescription can enhance stroke risk reduction therapy delivery in individuals with AF.
• To determine the effectiveness of pharmacist intervention in improving OAC adherence and stroke prevention.

Main Methods:

• A prospective, randomized clinical trial involving 27 community pharmacies in Alberta, Canada.
• Patients aged 65+ with AF and a stroke risk factor received either early or delayed pharmacist intervention for OAC prescription.
• Guideline-concordant OAC use at 3-month follow-up was the primary outcome measure.

Main Results:

• Guideline-concordant OAC use increased from 56.1% in the control group to 92.3% in the early intervention group at 3 months (P < .001).
• This represents an absolute increase of 34% in appropriate OAC use, with a number needed to treat of 3.
• Pharmacist intervention identified and treated actionable AF, including newly diagnosed cases.

Conclusions:

• Pharmacist-led OAC prescription is a highly effective strategy for addressing gaps in stroke risk reduction for AF patients.
• Further large-scale trials are necessary to confirm the scalability, sustainability, effectiveness, and safety of this intervention.