Optimizing the use of oral anticoagulant therapy for atrial fibrilation in primary care: a pharmacist-led intervention.

Virdee, Mandeep S.; Stewart, Derek

Abstract

Background: Updated evidence-based guidelines for the management of atrial fibrillation (AF) necessitate patient review, particularly with respect to oral anticoagulants, to ensure maximum health gain around stroke prophylaxis. Objective To quantify the level of anticoagulation utilisation in patients with a CHA2DS2-VASc≥1/≥2 (male/female) according to evidence-based guidelines and to assess the impact of a pharmacist-led intervention to optimise therapy. Setting: Fifteen general medical practices in Liverpool, North-West England with a practice population of 99,129. Method GRASP-AF software was employed to interrogate patient electronic medical records to identify and risk stratify AF patients (using CHA2DS2-VASc). A pharmacist then reviewed the medical records of those of patients not anticoagulated and with a CHA2DS2-VASc≥1/≥2 (male/female). Recommendations were discussed with a general practitioner (GP) and those patients in whom the need for anticoagulation was agreed were invited for a consultation with either the pharmacist or GP and therapy optimised where appropriate. The GPs were responsible for managing those patients referred for diagnosis confirmation or further specialist opinion. Main outcome measure: Proportion of patients eligible/not eligible for anticoagulation; proportions in whom anticoagulants initiated, refused, antiplatelets discontinued. Results: Five hundred and twenty-three patients (31% of patients identified with AF and a CHA2DS2-VASc≥1/≥2 (male/female)) were not receiving an anticoagulant (26 subsequently died or left the practice leaving 497). Three hundred and eighty-two (77%) pharmacist recommendations to a GP were agreed without modification. Following outcomes of diagnostic investigations and specialist referrals, 202 (41%) patients were candidates for anticoagulation, 251 (51%) were not eligible for anticoagulation, 103 (21%) were anticoagulated (56 warfarin, 47 DOAC). Conclusion: A pharmacist-led intervention re-aligned oral anticoagulant therapy to the latest evidence based guidelines for stroke prophylaxis, whilst simultaneously correcting the over-utilisation of antiplatelet therapy.

Citation

VIRDEE, M.S. and STEWART, D. 2017. Optimizing the use of oral anticoagulant therapy for atrial fibrilation in primary care: a pharmacist-led intervention. International journal of clinical pharmacy [online], 39(1), pages 173-180. Available from: https://doi.org/10.1007/s11096-016-0419-x

• Journal Article Type: Article
• Acceptance Date: Dec 21, 2016
• Online Publication Date: Jan 3, 2017
• Publication Date: Feb 28, 2017
• Deposit Date: Mar 9, 2017
• Publicly Available Date: Jan 4, 2018
• Journal: International journal of clinical pharmacy
• Print ISSN: 2210-7703
• Electronic ISSN: 2210-7711
• Publisher: Springer
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: 1
• Pages: 173-180
• DOI: https://doi.org/10.1007/s11096-016-0419-x
• Keywords: Anticoagulant; Atrial fibrillation; Pharmacist; Stroke; United Kingdom
• Public URL: http://hdl.handle.net/10059/2197