American Heart Association Launches Initiative to Include Pharmacists in Atrial Fibrillation Care

The American Heart Association has announced the launch of a new initiative to educate and engage with pharmacists, “an underrepresented voice” in atrial fibrillation (AFib) treatment.¹

The pharmacist collaboration is the latest phase in the American Heart Association’s Four F’s of Atrial Fibrillation initiative.² The “Four F’s” represent patient health concerns that interfere with guideline-directed anticoagulant therapy: fear of falling, fear of bleeding, forgetfulness, and frailty.^1,2

“Pharmacists are an integral part of the multidisciplinary care team to optimize care for individuals with atrial fibrillation,” said Cody Parsons, APh, PharmD, BCCCP, manager of clinical operations for Stanford Health Care’s cardiovascular health service line, in a news release.¹ “The insight of pharmacists in evaluating the medical complexity and use of multiple medications is essential in facilitating safe and effective anticoagulation and ultimately preventing life-altering medical consequences of AFib.”

Atrial fibrillation is the most common type of irregular heartbeat. | image credit: freshidea - stock.adobe.com

Despite their accessibility—and the high levels of trust patients hold for their pharmacists³—pharmacists are “often not consulted in the decision-making conversations” during a patient’s AFib care journey. As part of the initiative, the American Heart Association will hold a roundtable event with pharmacists to identify gaps and opportunities related to AFib treatment. Resources and insights from the event will be shared nationwide.

The initiative is supported by the Bristol-Myers Squibb-Pfizer Alliance. In 2007, the companies entered a worldwide collaboration to develop and commercialize the oral anticoagulant apixaban.⁴

READ MORE: Improving CVD Outcomes Through Better Recommendations, Patient Monitoring

AFib is the most common type of irregular heartbeat; estimates suggest that AFib will affect approximately 12.1 million adults in the US by 2030.¹ Rates of AFib diagnosis vary, with education, income, and clinical and genetic risk factors all playing a role: In White the overall lifetime AFib risk is 30% to 40%, compared with a 20% risk in African American individuals and a 15% risk in Chinese individuals.⁵ The condition has been associated with a 1.5-fold to 2-fold increased risk of death, as well as adverse outcomes such as stroke, cognitive impairment or dementia, myocardial infarction, sudden cardiac death, heart failure, chronic kidney disease, and peripheral artery disease.⁵

In 2023, the American College of Cardiology and the American Heart Association collaborated to update the 2014 and 2019 guidelines for the diagnosis and management of AFib, with the American College of Clinical Pharmacy and the Heart Rhythm Society serving as additional collaborators; both organizations also endorsed the guidelines.⁴

In addition to lifestyle and risk factor modification and device management, the guidelines also focused on the role of anticoagulation therapies in the management of AFib. “Updated guidance on the management of heart rate and rhythm medications, use of anticoagulants, and when to potentially pause or stop these therapies is also a focus of the new guidelines,” noted the authors of an article from the American College of Cardiology.⁶ The full guidelines are available in Circulation⁴ and in the Journal of the American College of Cardiology.⁷

READ MORE: Cardiovascular Care Inequities Lead to Worse Outcomes for Women With Atrial Fibrillation

“The new guideline reinforces the urgent need to approach AFib as a complex cardiovascular condition that requires disease prevention, risk factor modification, as well as optimizing therapies and patients’ access to care and ongoing, long-term management,” said Jose Joglar, MD, FACC, chair of the guideline writing committee, in a news release.⁶ “This is a complex disease. It’s not just an isolated disorder of the heart’s rhythm, and we now know that the longer someone is in AFib, the harder it is to get them back to normal sinus rhythm.”

In August 2020, the American Journal of Medicine⁸ published an article noting that pharmacists are a “potentially untapped resource” in AFib care, particularly in the delivery of Atrial Fibrillation Better Care pathway delivery—the gold standard integrated care strategy for AFib management across Europe and Asia-Pacific regions. Authors of that study noted that the current pharmacy service framework “needs restructuring to support translation of pharmacist interventions into everyday clinical practice, and with scope for these to include prescribing.”

READ MORE: Cardiology Resource Center

References

1. Engaging pharmacists to improve atrial fibrillation care. News release. American Heart Association. April 23, 2024. Accessed April 25, 2024. https://newsroom.heart.org/news/engaging-pharmacists-to-improve-atrial-fibrillation-care

2. Walter M. American Heart Association things pharmacists can play a bigger role in AFib care. Cardiovascular Business. April 24, 2024. Accessed April 25, 2024. https://cardiovascularbusiness.com/topics/clinical/heart-rhythm/american-heart-association-thinks-pharmacists-can-play-bigger-role-afib-care

3. Pharmacists ranked third most trusted medical professionals in 2023 Gallup survey. National Association of Boards of Pharmacy. March 22, 2024. Accessed April 25, 2024. https://nabp.pharmacy/news/blog/regulatory_news/pharmacists-ranked-third-trusted-medical-professionals/

4. Profile: Bristol Myers Squibb and Pfizer Alliance. American College of Emergency Physicians Partner Collaborative. Accessed April 25, 2024. https://www.acep.org/apc/attendees-bios/partners/profile---bristol-pfizer-alliance

5. Joglar JA, Chung MK, Armbruster AL, et al; Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR0000000000001193

6. New ACC/AHA guideline focuses on diagnosis, management of afib. American College of Cardiology. November 30, 2023. Accessed April 25, 2024. https://www.acc.org/Latest-in-Cardiology/Articles/2023/11/29/18/58/New-ACC-AHA-Guideline-Focuses-on-Diagnosis-Management-of-AFib-gl-af

7. Joglar JA, Chung MK, Armbruster AL, et al; Writing Committee Members. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2024;83(1):109-279. Doi:10.1016/j.jacc.2023.08.017

8. Ritchie LA, Penson PE, Akpan A, Lip GYH, Lane DA. Integrated care for atrial fibrillation management: the role of the pharmacist. Am J Med. 2022;135(12):1410-1426. Doi:10.1016/j.amjmed.2022.07.014