Improving Stroke Prevention in Atrial Fibrillation Through Pharmacist Prescribing "PIAAF Rx"


Phase 4 Results N/A

Trial Description

The purpose of this study is to compare the effectiveness of prescribing oral anticoagulation therapy by pharmacist intervention compared to enhanced usual care in participants with unrecognized AF and/or known AF but not taking blood thinners.

Detailed Description

AF is the most common arrhythmia and the leading cause of stroke. Despite robust evidence oral anticoagulation (OAC) therapy is effective and safe for stroke prevention in patients with AF; there is a lack of real-world application. Alternative strategies to deliver stroke prevention therapy need to be explored. Although pharmacists' prescribing of antihypertensive and lipid lowering drug therapy has been shown to increase adherence to guideline-based targets and warfarin management improve control of international normalized ratios in anticoagulation clinics, the role of pharmacist initiation of OAC therapy compared to usual care in AF patients for stroke prevention in a community setting is unclear.
In this study, the investigators will screen participants presenting to community pharmacies to identify participants with unrecognized AF and/or known AF but not taking blood thinners or not on optimal OAC therapy and randomize care to either the pharmacist or enhanced usual care (family physician notification by pharmacist).



  • Anticoagulants Drug
    Other Names: warfarin and novel oral anticoagulants
    Intervention Desc: Anticoagulant therapy will be initiated/titrated in patients with atrial fibrillation in accordance with the Canadian Cardiovascular Society Guidelines for Atrial Fibrillation.
    ARM 1: Kind: Experimental
    Label: Active Pharmacist Arm
    Description: OAC therapy will be initiated/adjusted by the community pharmacist in accordance to the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.
    ARM 2: Kind: Experimental
    Label: Enhanced Usual Care Arm
    Description: Pharmacist will be refer participants to their physician in regards to OAC therapy for atrial fibrillation. The pharmacist will provide a current medication list to the physician as well as notification of a new diagnosis of atrial fibrillation


Type Measure Time Frame Safety Issue
Primary Optimal Oral Anticoagulant (OAC) Therapy for Atrial Fibrillation Stroke Prevention 3 months
Secondary Prevalence of AF Through study completion, an average of 1 year
Secondary Patient Satisfaction with Pharmacists Services 3 months
Secondary Qualitative Assessment of Implementation by Pharmacist Through study completion, an average of 1 year
Secondary Healthcare Utilization One year