The role of pharmacists in the management of patients with atrial fibrillation: A systematic review and meta-analysis.

Tonin, FS; Tsuyuki, RT; Fernandez-Llimos, F; Garcia-Cardenas, V; Laufs, U; Schulz, M

The role of pharmacists in the management of patients with atrial fibrillation: A systematic review and meta-analysis.

Tonin, FS Tsuyuki, RT Fernandez-Llimos, F Garcia-Cardenas, V Laufs, U Schulz, M

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Publisher:: SAGE PUBLICATIONS INC
Publication Type:: Journal Article
Citation:: Can Pharm J (Ott), 2025, 158, (6), pp. 351-367
Issue Date:: 2025

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Field	Value	Language
dc.contributor.author	Tonin, FS
dc.contributor.author	Tsuyuki, RT
dc.contributor.author	Fernandez-Llimos, F
dc.contributor.author	Garcia-Cardenas, V
dc.contributor.author	Laufs, U
dc.contributor.author	Schulz, M https://orcid.org/0000-0002-5876-7322
dc.date.accessioned	2026-02-03T08:30:44Z
dc.date.available	2025-07-11
dc.date.available	2026-02-03T08:30:44Z
dc.date.issued	2025
dc.identifier.citation	Can Pharm J (Ott), 2025, 158, (6), pp. 351-367
dc.identifier.issn	1715-1635
dc.identifier.issn	1913-701X
dc.identifier.uri	http://hdl.handle.net/10453/192793
dc.description.abstract	BACKGROUND: Pharmacist-led interventions have demonstrated benefits across various medical conditions; however, their impact on atrial fibrillation (AF) remains unexplored. This study aims to synthesize the available evidence regarding the pharmacist's role in AF management. METHODS: A systematic review with searches in PubMed, Scopus, and Web of Science was performed (PROSPERO: CRD42025647848). Randomized and non-randomized trials, as well as cohort studies reporting clinical, process, and humanistic outcomes, were included. Findings were pooled through pairwise meta-analyses. Dichotomous outcomes were reported as risk ratios (RRs) and continuous variables as standardized mean differences (SMDs) with 95% confidence intervals (CIs). The quality of the randomized and non-randomized studies was assessed using RoB 2.0 and ROBINS-I tools, respectively. Evidence was graded using the GRADE approach. RESULTS: Seventeen studies (n = 11,428 participants) published between 2008 and 2024, predominantly as non-randomized trials/cohorts (77%), were included. Pharmacist-led interventions varied widely in scope, including anticoagulation management services, medication therapy management, and prescribing. Meta-analyses showed that pharmacists improved time in therapeutic range (SMD 0.35; 95% CI, 0.13-0.56) and reduced major bleeding events (RR 0.76; 95% CI, 0.61-0.95) and strokes (RR 0.65; 95% CI, 0.44-0.94) compared with usual care. Pharmacist care also increased appropriate prescription rates (RR 1.36, 95% CI, 1.18-1.56). No significant differences were found for other outcomes. Evidence was of low-to-moderate certainty. INTERPRETATION: Pharmacist-led interventions have been shown to improve certain clinical and process outcomes in AF. CONCLUSIONS: High-quality randomized studies with well-defined interventions are still needed to better refine the pharmacist's role in AF care and to identify the most effective intervention in practice (see Graphical Abstract). Can Pharm J (Ott) 2025;158:xx-xx.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	SAGE PUBLICATIONS INC
dc.relation.ispartof	Can Pharm J (Ott)
dc.relation.isbasedon	10.1177/17151635251365148
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	Pharmacology & Pharmacy
dc.subject.classification	3214 Pharmacology and pharmaceutical sciences
dc.title	The role of pharmacists in the management of patients with atrial fibrillation: A systematic review and meta-analysis.
dc.type	Journal Article
utslib.citation.volume	158
utslib.location.activity	United States
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2026-02-03T08:30:41Z
pubs.issue	6
pubs.publication-status	Published online
pubs.volume	158
utslib.citation.issue	6

Abstract:

BACKGROUND: Pharmacist-led interventions have demonstrated benefits across various medical conditions; however, their impact on atrial fibrillation (AF) remains unexplored. This study aims to synthesize the available evidence regarding the pharmacist's role in AF management. METHODS: A systematic review with searches in PubMed, Scopus, and Web of Science was performed (PROSPERO: CRD42025647848). Randomized and non-randomized trials, as well as cohort studies reporting clinical, process, and humanistic outcomes, were included. Findings were pooled through pairwise meta-analyses. Dichotomous outcomes were reported as risk ratios (RRs) and continuous variables as standardized mean differences (SMDs) with 95% confidence intervals (CIs). The quality of the randomized and non-randomized studies was assessed using RoB 2.0 and ROBINS-I tools, respectively. Evidence was graded using the GRADE approach. RESULTS: Seventeen studies (n = 11,428 participants) published between 2008 and 2024, predominantly as non-randomized trials/cohorts (77%), were included. Pharmacist-led interventions varied widely in scope, including anticoagulation management services, medication therapy management, and prescribing. Meta-analyses showed that pharmacists improved time in therapeutic range (SMD 0.35; 95% CI, 0.13-0.56) and reduced major bleeding events (RR 0.76; 95% CI, 0.61-0.95) and strokes (RR 0.65; 95% CI, 0.44-0.94) compared with usual care. Pharmacist care also increased appropriate prescription rates (RR 1.36, 95% CI, 1.18-1.56). No significant differences were found for other outcomes. Evidence was of low-to-moderate certainty. INTERPRETATION: Pharmacist-led interventions have been shown to improve certain clinical and process outcomes in AF. CONCLUSIONS: High-quality randomized studies with well-defined interventions are still needed to better refine the pharmacist's role in AF care and to identify the most effective intervention in practice (see Graphical Abstract). Can Pharm J (Ott) 2025;158:xx-xx.

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