New study identifies key role for pharmacists in reducing stroke risk

According to Dr. Roopinder Sandhu, MD, MPH, atrial fibrillation (Afib) is the most common cardiac arrhythmia in clinical practice, and the leading cause of stroke in older individuals. Sandhu, a cardiac electrophysiologist and director of the Women’s Cardiovascular Health Initiative at the Cumming School of Medicine, University of Calgary, says that despite the availability of blood thinners that are highly effective and safe for reducing the risk of stroke, there are major gaps in administration are The number of suitable blood thinners remains, leaving a large proportion of people at risk of stroke and other complications.

Sandhu led a study investigating whether involving community pharmacists in prescribing appropriate blood thinners for individuals with undiagnosed or undertreated Afib could improve stroke prevention. The findings are published in the news JAMA network opened.

“People visit their pharmacist up to eight times more often than their doctor. Pharmacists have long-term, trusting relationships with the people who come to them for medicines and advice about the medicines they take,” says Sandhu, first author and lead researcher. “Also, access to a pharmacist can be easier than access to a GP for many people, especially for people in remote communities.”

The research team worked with pharmacists in 27 communities in Alberta who are specially trained in Afib and prescribing blood thinners. The pharmacists recruited 80 patients over 65 years of age with one additional risk factor for stroke, such as diabetes, hypertension or heart failure, and known, untreated Afib (no blood thinner or suboptimal dose of blood thinner), or performed screening to previously detect non- diagnosed Afib.

“We set up heart health stations in participating pharmacies where people could check their blood pressure and heart rhythm using a mobile electrocardiogram (ECG), a digital tool that can read your heart rhythm. The heart rhythm measurements were sent to two cardiologists for analysis,” says Miriam Fradette, co-researcher and pharmacist. “When the cardiologists confirmed an irregular rhythm, the person was booked through the healthcare system for a new ECG and their doctor was notified.”

Study participants were randomized into two groups; one group was identified as the early intervention group and continued to consult with the pharmacist, the other group was advised to speak with their GP. If the second group had not seen their doctor after three months, the pharmacist worked directly with them and kept the doctor informed. Both groups were followed for a year.

“The findings show that allowing trained, community-based pharmacists to prescribe to this group increased the number of at-risk patients taking optimal blood thinners for stroke prevention by 34 percent,” says Sandhu. “I knew there would be a difference between the groups, but I didn’t realize how big it would be. This collaborative care model that leverages the expertise of pharmacists could have a far-reaching impact in addressing the high number of people going untreated. or are under-treated for Afib and are at risk of stroke, especially as several countries have moved to independent pharmacist prescribing or through partnership agreements.”

Sandhu adds that it is important that an infrastructure exists for pharmacists to conduct patient assessments; ordering and interpreting labs; initiating, adjusting and monitoring drug therapy; access to electronic medical records; and work in a collaborative care model with physicians.

“The results of this study provide an innovative solution to increase the use of evidence-based anticoagulation therapy to prevent stroke in patients with atrial fibrillation,” said Dr. Jeff Healey, cardiologist and co-researcher. “This study is the result of a multi-year cross-Canada collaboration initiated by the Canadian Stroke Prevention Intervention Network (CSPIN).”