RT Journal Article
SR Electronic
T1 Pharmacist-led interventions in optimising the use of oral anticoagulants in patients with atrial fibrillation in general practice in England: a retrospective observational study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2023.0113
DO 10.3399/BJGPO.2023.0113
VO 8
IS 2
A1 Sharma, Raman
A1 Hasan, Syed Shahzad
A1 Gilkar, Ishtiaq A
A1 Hussain, Waheed F
A1 Conway, Barbara R
A1 Ghori, Muhammad Usman
YR 2024
UL http://bjgpopen.org/content/8/2/BJGPO.2023.0113.abstract
AB Background Oral 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 patients with AF. However, prescribing DOACs for patients with established AF poses various challenges and general practice pharmacists may have an important role in supporting their management.Aim To investigate the effectiveness of pharmacist-led interventions in general practice in optimising the use of OAC therapies in AF.Design & setting A retrospective observational study in general practices in Bradford.Method The data were collected retrospectively from 1 November 2018–31 December 2019 using electronic health record data. The data were analysed: 1) to identify patients with AF not on OAC; 2) to describe inappropriate DOAC prescriptions; and 3) to calculate HAS-BLED scores.Results Overall, 76.3% (n = 470) of patients with AF received OAC therapy, and of these, 63.4% received DOACs. Pharmacist-led interventions increased DOAC prescribing by 6.0% (P = 0.03). Inappropriate DOAC use was identified in 24.5% of patients with AF, with underdosed and overdosed identified in 9.7% and 14.8%, respectively. Post-intervention, inappropriate prescribing was reduced to 1.7%. The mean HAS-BLED score decreased from 3.00 to 2.22 (P<0.01). Successful transition from vitamin K antagonist (VKA) therapy to DOACs was achieved in 25.7% of patients.Conclusion Pharmacist-led interventions have successfully improved the use of OAC therapies in patients with AF, and effectively managed the bleeding risks and transition from VKA to DOAC therapy, in line with guidelines.