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Peer-reviewedCC BY-NC-NDHeart rhythm O2

Pharmacist management of oral anticoagulation for atrial fibrillation in the community: The APOTHECARY AF study.

  • Ciantel Adair Blyler1
  • Elizabeth M Jones1,2
  • Brian S Mittman3
  • Steven W Chen4
  • Christine M Albert1,5
  • Roopinder K Sandhu1,6
  • APOTHECARY AF Collaborators
6 affiliations
  1. 1Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California.
  2. 2Sutter Medical Center-Sacramento, Sacramento, California.
  3. 3Kaiser Permanente, Department of Research & Evaluation, Los Angeles, California.
  4. 4University of Southern California, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California.
  5. 5Mass General Brigham, Department of Cardiology, Boston, Massachusetts.
  6. 6University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada.
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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.

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Cite

BibTeXRIS
BibTeX
@article{blyler2026pharmacist,
  title = {{Pharmacist management of oral anticoagulation for atrial fibrillation in the community: The APOTHECARY AF study.}},
  author = {Ciantel Adair Blyler and Elizabeth M Jones and Brian S Mittman and Steven W Chen and Christine M Albert and Roopinder K Sandhu and APOTHECARY AF Collaborators},
  journal = {Heart rhythm O2},
  year = {2026},
  month = aug,
  doi = {10.1016/j.hroo.2026.07.012},
  url = {https://europepmc.org/article/MED/42936080},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Pharmacist management of oral anticoagulation for atrial fibrillation in the community: The APOTHECARY AF study.
AU  - Ciantel Adair Blyler
AU  - Elizabeth M Jones
AU  - Brian S Mittman
AU  - Steven W Chen
AU  - Christine M Albert
AU  - Roopinder K Sandhu
AU  - APOTHECARY AF Collaborators
PY  - 2026
DA  - 2026/08/07
JO  - Heart rhythm O2
DO  - 10.1016/j.hroo.2026.07.012
UR  - https://europepmc.org/article/MED/42936080
AB  - 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.
SN  - 2666-5018
ER  -