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Pharmacists have future role in atrial fibrillation management

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AFIB

Loren Bonner

Pharmacists are a potentially untapped resource for atrial fibrillation (AFib) management, according to a new research paper in the American Journal of Medicine. The authors make the case that a pharmacist's skill set places them in the perfect position to put integrated AFib care into practice across the continuum of health care.

“While it's not surprising to see that pharmacists improve care, what's most surprising is the sheer amount of literature supporting [pharmacists’] role in the management of atrial fibrillation,” said Caitlin Gibson, PharmD, BCPS, BCCP, who was not involved with the research.

Dozens of studies, which are put forth in the paper, demonstrate the value that pharmacists add to the collaborative care of patients with AFib. Gibson, who is an associate professor at Virginia Commonwealth University School of Pharmacy, noted that more data on how to best train pharmacists for participation in these initiatives is warranted as well.

“Pharmacists should continue to publish on their initiatives—successful or not—so that our profession can further delineate best practices and focus our resources and efforts on meaningful initiatives,” she said.

“Gold standard”

In the paper published August 20, 2022, the researchers summarized the findings from previous research studies of pharmacist interventions that can be mapped to the “CC to ABC” model for patients with AFib.

The Atrial Fibrillation Better Care (ABC) pathway—the “gold standard” within Europe and Asia-Pacific—was first proposed in 2017 as a framework for integrated care to align generalist and specialist AFib management across health care settings.

The pathway is comprised of: Anticoagulation/Avoid stroke (A), Better symptom management (B), and Cardiovascular and other comorbidity optimization (C). European guidelines not only recommend the ABC pathway, but they also highlight two steps that precede the ABC pathway in practice: “CC to ABC.” This consists of “C”—Confirming the AFib diagnosis with a 12-lead electrocardiogram (ECG) or single-lead ECG tracing of ≥ 30 seconds, followed by “C”—Characterization of AFib including stroke risk, symptom severity, severity of AFib burden, and substrate severity.

“As the scope of pharmacist practice continues to evolve and includes prescribing, it seems feasible for pharmacists to deliver all components of the ABC pathway across the health care continuum,” the study authors conclude. “Hospital pharmacists could perform targeted medication reviews for atrial fibrillation patients, optimizing therapies with cardiology input as needed and providing education. In primary care, pharmacists could lead screening programs, check medication adherence, provide new medicine reviews, monitor for adverse effects, monitor blood pressure, blood glucose, and cholesterol, and reinforce key educational messages.”

Growth in the U.S.

The research paper characterizes the role pharmacists have played in screening for AFib in Europe and Australasia.

While this practice is much less common in the United States, Gibson said it represents a potential area to expand pharmacy services under collaborative practice agreements or through new initiatives in community pharmacies.

The paper does confirm the value of many common pharmacy practices in the United States, however, such as anticoagulation management clinics, as well as optimization of rate and rhythm control therapy in ambulatory and hospitalized patients.

“As a U.S.-based pharmacist, I'm interested to learn how pharmacists contribute to patient care in other countries,” Gibson said. “A significant number of screening interventions outside of the U.S. occur in community pharmacies; this may be an underutilized opportunity for pharmacists in critical access areas or underserved communities to identify and care for patients living with atrial fibrillation.”

The practices highlighted in the research run the gamut—from community to outpatient to hospitals—which Gibson said only demonstrates “the tremendous breadth and depth of our ability to manage symptoms, optimize anticoagulation to prevent strokes, improve patient satisfaction and knowledge, and ultimately improve patient outcomes.”

In fact, the APhA Foundation developed the Solution for Atrial Fibrillation Edvocacy (SAFE) project, which puts the focus on community pharmacy practice settings as an access point for AFib screening, detection, and referral to a physician.

“Pharmacists are well-positioned to offer these patient care services due to the frequency of patient interactions,” said Benjamin Bluml, RPh, APhA Foundation executive director and senior vice president of research and innovation. “Through this project we've seen pharmacists bring hundreds of patients into a shared decision-making process and facilitate a team-based approach to care. We're extremely proud of the pharmacists we've partnered with across the U.S.”

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