Pharmacist-Led interventions in optimising the use of oral anticoagulants in atrial fibrillation patients in the general practice in England: A retrospective observational study

Abstract

BackgroundOral anticoagulation (OAC) is the mainstay of treatment for the prevention of strokes in patients with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) account for increasing OAC in AF patients. However, prescribing DOACs for patients with established AF poses various challenges and general practice pharmacists may have an important role in supporting their management.AimInvestigating the effectiveness of pharmacist-led interventions in general practice in optimising the use of OAC therapies in AF.Design & settingA retrospective observational study in the central Bradford general practices. using electronic health record data with atrial fibrillation in central Bradford general practices.MethodThe data was collected retrospectively from 1stNovember 2018 to 31stDecember 2019 using electronic health record data. The data were analysed: (i) to identify AF patients not on OAC; (ii) to describe inappropriate DOACs prescriptions; and (iii) to calculate HASBLED scores.Results76% of patients with AF received OAC therapy, and of these, 48% received DOACs. Pharmacist-led interventions increased DOAC prescribing by 6% (P=0.03). Inappropriate DOAC use was identified in 25%, with underdosed and overdosed were 10% and 15%, respectively. After an intervention, this was reduced to 1.5%. The mean HASBLED score decreased from 3.00 vs 2.22 (P<0.01). Successful transition from VKA (vitamin K antagonist) therapy to DOACs was achieved in 25.71% of patients.ConclusionPharmacist-led interventions have successfully improved the use of OAC therapies in AF patients and effectively managed the bleeding risks and transition from VKA to DOAC therapy, in line with guidelines.