Pharmacist-led intervention for older people with atrial fibrillation in long-term care (PIVOTALL study): a randomised pilot and feasibility study

Figures

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  Fig. 1. Flow diagram of care home recruitment. ainitial introduction to care home facilitated by Mersey Care NHS Foundation Trust medicines management pharmacists (n = 7), consultant geriatrician (n = 7), community matron (n = 3), general practice-based physician associate (n = 1), general practitioner (n = 1), care home manager of participating care home (n = 3). ball care homes that did not respond were contacted at least once more

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  Fig. 2. Flow diagram of participant recruitment. EMIS; Egton Medical Information Systems; LPA, Lasting Power of Attorney. aLPA for Health and Welfare. bdetails of study unknown

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  Fig. 3. Completion rate of resident self-report researcher-administered questionnaires and researcher-administered assessments at baseline and six months. AFEQT, Atrial Fibrillation Effect on Quality of Life; 6-CIT, 6-item Cognitive Impairment Test; EFS-AC, Edmonton Frail Scale – Acute Care; EQ-5D-5L, EuroQol-5-Dimensions-5-Levels questionnaire; mEHRA, modified European Heart Rhythm Association; VAS, visual analogue scale

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  Fig. 4. Adherence to the Atrial Fibrillation Better Care pathway and pharmacist recommendations in the event of non-adherence. AF, atrial fibrillation; ACEI, angiotensin converting enzyme inhibitor; AKI, acute kidney injury; BB, beta-blocker; BP, blood pressure; EHRA, European Heart Rhythm Association; ESRD, end stage renal disease; GI, gastrointestinal; HbA1c, glycated haemoglobin; HFpEF, heart failure with preserved ejection fraction (≥ 50%); HFrEF, heart failure with reduced ejection fraction (< 40%); HR, heart rate; LFTs, liver function tests; NOAC, non-vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; TTR, time in therapeutic range; VKA, vitamin K antagonist

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  Fig. 5. Number and type of all pharmacist medicines recommendations and implementation rates at six month follow-up. HbA1c, glycated haemoglobin; IR, immediate release; MR, modified release; NOAC, non-vitamin K antagonist oral anticoagulant; VKA, vitamin K antagonist. *two ABC-specific recommendations for one resident to (1) review diltiazem and bisoprolol in a resident with heart failure and then (2) review antihypertensive medications accordingly (readings > 140/85 mmHg), two non-ABC specific recommendations to rationalise bendroflumethiazide/perindopril in a resident with hypotension, and rationalise linagliptin in a diabetic resident with a HbA1c of 42 mmol/mol. **one ABC-specific recommendation to repeat HbA1c in a resident with documented history of type 2 diabetes but no record of blood glucose levels, HbA1c or prescription of antidiabetic medicines, one non-ABC specific recommendation to repeat HbA1c in a resident with type 2 diabetes who had gliclazide stopped with no repeat HbA1c. ***ABC-specific recommendation for a resident on warfarin with time in therapeutic range < 70%