A pharmacist-led multidisciplinary intervention significantly increased overall antithrombotic use in elderly patients with atrial fibrillation from 59.6% at admission to 81.2% at discharge (P<.001).
Observational (n=218)
No
Does a pharmacist-led multidisciplinary intervention increase the proportion of elderly patients with atrial fibrillation receiving appropriate antithrombotic therapy?
A pharmacist-led multidisciplinary intervention significantly increased the appropriate use of antithrombotic therapy in elderly hospitalized patients with atrial fibrillation.
Absolute Event Rate: 81.2% vs 59.6%
p-value: p=<.001
OBJECTIVES: To develop, implement, and evaluate a pharmacist-led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested. DESIGN: Evidence-based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patient's requirement for antithrombotic therapy was assessed. SETTING: A major Sydney teaching hospital. PARTICIPANTS: Two hundred eighteen consecutively admitted elderly patients (mean age 85.2) were recruited over a 6-month period. INTERVENTION: A pharmacist-coordinated multidisciplinary review process was implemented to coordinate risk assessments and subsequently recommend appropriate antithrombotic therapy, as per the algorithms. MEASUREMENTS: The proportion of patients receiving antithrombotic therapy was assessed on admission (preintervention), at discharge (postintervention), and postdischarge (follow-up at 3 and 6 months). RESULTS: As a result of the intervention, 78 patients (35.8%) required changes to their existing antithrombotic therapy. Of these changes, 60 (76.9%) were "upgrades" to more-effective treatment options (e.g., from no therapy to any agent or from aspirin to warfarin). The remaining 18 (23.1%) changes were "downgrades" to less-effective, albeit safer, options. Despite a significant increase in anti thrombotic use overall (59.6% vs 81.2%, P<.001), fewer patients received warfarin postintervention, after having been assessed as inappropriate candidates (20.7% vs 17.4%, P=.39). CONCLUSION: A pharmacist-led multidisciplinary process was successfully developed and implemented within the hospital setting to increase overall antithrombotic use. Having addressed some of the known barriers and limitations to warfarin use, these algorithms may allow allied health workers, patients, and clinicians to work collaboratively to achieve optimal and, importantly, appropriate (i.e., safe and effective) antithrombotic use in at-risk elderly patients.
Bajorek et al. (Thu,) conducted a observational in Atrial Fibrillation (n=218). Pharmacist-led multidisciplinary intervention vs. Preintervention (admission) was evaluated on Proportion of patients receiving antithrombotic therapy (p=<.001). A pharmacist-led multidisciplinary intervention significantly increased overall antithrombotic use in elderly patients with atrial fibrillation from 59.6% at admission to 81.2% at discharge (P<.001).