The Impact of Clinical Pharmacist Managed Anticoagulation Management Service Versus Routine Medical Care on the Clinical Outcome of Atrial Fibrillation Patients

Abstract

Atrial Fibrillation (AF) is a heart rhythm disorder of the atria associated with deadly and debilitating consequences including heart failure, stroke, poor mental health, reduced quality of life and death (Stewart S, Hart CL et al. 2002) . The prevalence of atrial fibrillation is increasing particularly in developing countries due to the aging population (Go AS, Hylek EM et al. 2003). Two treatment approaches cornerstone the management of AF. One is to correct the faulty heartbeat, and the other is to manage the risk of stroke by preventing the formation of clots in the fibrillating heart (Iqbal M.B, Taneja A.K et al. 2005). Warfarin has been shown to reduce the risk of stroke in patients with AF in both clinical trials and clinical practice. Importantly, warfarin has proven efficacy in reducing the risk of severe, fatal or disabling strokes. In addition, anticoagulation with warfarin has been demonstrated to be cost-effective in patients with AF & a moderate-to- high risk of stroke (Fuster V, Ryden L.E et al. 2006). However, warfarin administration is associated with major, well-recognized drawbacks. Despite the useful anticoagulant activity, warfarin has a narrow therapeutic index in which it is both safe and effective. Maintaining warfarin within this range is also complicated by interactions with food and other drugs that can significantly alter blood levels of warfarin regardless of the dose taken (Hart R G, Pearce L A et al. 2000). Summary 87 For monitoring, usually the INR (International Normalized Ratio) is the standard test which represents the ratio between the test result and a standard pro-thrombin time (Fuster V, Ryden L.E et al. 2006). Many patients have a poor understanding of AF as a disease and its pharmacotherapeutic requirements . In the US, Anticoagulation Management Service is one of the standards of care offered to patients on anticoagulation. It employs a focused and coordinated approach to managing anticoagulation (Macik BG 2003).They have sometimes been considered the gold standard of warfarin management (Macik BG 2003) helping to increase the time that a patient’s INR values are within the target range, improve the overall cost-effectiveness of therapy, increase patient adherence and provide valuable information for both healthcare professionals and patients (Ansell J, Hollowell J et al. 2007). However, in Egypt till now anticoagulation management service is lacking with only routine medical care availability that lacks proper patient education, follow up and monitoring for adverse drug events. The current situation has initiated our proposal to investigate the impact of such service on patient outcome. Another obstacle to achieving good control of anticoagulation among atrial fibrillation patients in Egypt is the relatively poor structure and processes of care in government hospitals and primary health care units. The aim of the current study was to evaluate the role of a pharmacist managed anticoagulation management service on atrial fibrillation patients’ INR control, frequency of acute complications, drug and food interactions and level of anticoagulation education