Pharmacist management of oral anticoagulation for atrial fibrillation in the community: The APOTHECARY AF study
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: Background: We developed a novel, community pharmacy-based, pharmacist-driven atrial fibrillation (AF) stroke prevention model involving pharmacist prescription of oral anticoagulants (OAC) in Alberta, Canada. Generalizability to healthcare systems outside Canada is unknown. Objective: We recruited 5 California pharmacies for a proof-of-concept pilot study aimed at evaluating the prevalence of "actionable" AF and the feasibility, safety, and barriers to implementing a pharmacist OAC prescription program. Methods: Before implementation, pharmacist and physician stakeholders were surveyed to identify potential barriers. Pharmacists identified adults aged ≥60 years with a CHA2DS2-VASc score of ≥2 (men) or ≥3 (women), and "actionable" AF, defined as (1) untreated, (2) sub-optimally treated, or (3) inappropriately treated. Participants were enrolled in a 3-month intervention in which pharmacists optimized OAC. Participant satisfaction was assessed at 3 months. Safety endpoints were assessed at 6, 9, and 12 months. Pharmacist-reported implementation barriers were assessed at 1 and 3 months. Results: "Actionable" AF prevalence ranged from 14% to 41%. A total of 14 participants were enrolled. At baseline, 50% of participants were untreated, whereas 50% were sub-optimally treated. At 3 months, 91% of participants were on guideline-concordant OAC therapy. There were no major bleeding events and no prescription overrides. Participants reported high satisfaction with pharmacist services. Perceived barriers reflected reported the following implementation challenges: (1) lack of time, (2) insufficient access to medical records, and (3) adequate reimbursement. Conclusion: Community-based, pharmacist-driven OAC prescription offers an opportunity to effectively close gaps in stroke risk reduction therapy for patients with AF. Scalability in the United States will depend on policy and infrastructure changes that address implementation challenges. Trial Registration: ClinicalTrials.gov Identifier: NCT04907825.
Source: Heart Rhythm O2
Authors: Ciantel Adair Blyler, Elizabeth M. Jones, Brian S. Mittman, Steven W. Chen, Christine M. Albert, Roopinder K. Sandhu, Kallie Amer, Leah Amirian, Ghada Ashkar, Nazeli Bairamian, Ani Darakchyan, Joseph Ebinger, Miriam Fradette, Robert I. Goodman, Tram Hoang, Lalima Hoq, Nicole Kashfian, Roger Lee, Jenny Lo, Jean Ly, Sevak Olmessekian, Leilani Padilla, Florian Rader, Jo Marie Reilly, Rita Shane, Raffi Svadjian, Gregory L. Taylor, Mary Tran, Ramesh Upadhyayula, Natalie Valadez, Jessican Wang, Karen Youmbi
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,150
Funder: National Institute on Aging
OpenAlex ID: W7196985044