Patient perspectives on atrial fibrillation management and pharmacist roles in outpatient clinics: a qualitative study.

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and mortality. Effective management requires both patient engagement and clear understanding of treatment goals yet evidence suggests persistent gaps in knowledge and involvement in care. Pharmacists are increasingly involved in AF clinics, yet little is known about how patients perceive their role, particularly in the context of potential pharmacist prescribing. AIM: To explore patients' perspectives on the management of AF and the role of pharmacists in an Irish outpatient AF clinic, including attitudes toward potential pharmacist prescribing. METHOD: A qualitative study was conducted using 15 one-to-one semi-structured interviews with adults aged ≥ 65 years attending a specialist AF clinic at Tallaght University Hospital, Dublin, Ireland. Interviews took place between March and May 2025. Participants were purposively sampled to capture a range of clinical and demographic characteristics. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's six-step reflexive thematic analysis. An inductive approach was adopted. Coding and theme development were conducted iteratively, with a subset of transcripts independently reviewed by supervisors to enhance analytical rigour and consistency. RESULTS: Five overarching themes were identified relating to understanding of AF, pharmacotherapy, satisfaction with care, perceptions of the pharmacist's role, and views on pharmacist prescribing. Participants demonstrated variable understanding of AF, with limited awareness of stroke risk despite consistent recognition of anticoagulant therapy. Knowledge of anticoagulant safety, particularly bleeding risk, was strong and well retained, whereas understanding of rate-control medicines was limited. Satisfaction with care was high; however, most participants adopted a passive role in decision-making, expressing trust in healthcare professionals. Pharmacists were frequently misidentified as doctors or nurses, reflecting limited role visibility. Once recognised, pharmacist input, particularly in anticoagulant counselling and medication advice, was highly valued. Views on pharmacist prescribing were mixed: while participants acknowledged pharmacists' expertise in medicines, many preferred doctors to retain prescribing responsibility due to established trust. CONCLUSION: While patients spoke positively about pharmacists' input, many struggled to identify the pharmacist within the clinic and were unclear about the scope of their role. Gaps in understanding of stroke risk and broader treatment goals highlight the need for structured patient education. As Ireland considers expanding pharmacist prescribing beyond the current common conditions scheme in community pharmacy, strengthening patient education and fostering trust will be essential to optimise pharmacist-led AF services.