Pharmacist-Led Atrial Fibrillation Clinic Accelerates Access to Physician Care

Pharmacists are skilled communicators who excel at understanding medical information and solving complex problems. Globally, research supports pharmacists’ important responsibilities on collaborative health care teams, especially when managing complicated health issues such as atrial fibrillation (AF).¹

AF has become more prevalent globally over the past 3 decades. Patients with AF have a higher risk of hospitalization than those without, largely because of problems from drug therapies, increased heart failure potential, and breakthrough AF. Prompt access to anticoagulant drug therapy when a patient is diagnosed with AF is critical to decrease the probability of long-term health complications and stroke.¹

Retrospective study findings published in Research in Social and Administrative Pharmacy assessed the effectiveness of a Rapid Access Atrial Fibrillation (RAAF) clinic staffed by cardiologists and pharmacists in Victoria, Australia. The analysis covered the period from April 2022 to November 2023.¹

Researchers developed a pharmacist-physician model of care to facilitate the speed of patient-to-provider referral and ultimately provide prompt care to patients with AF. Although such systems may not be necessary in locations with high specialty provider concentration, the location of the RAAF clinic had limited access to cardiologists, making the findings significant.¹

The program’s goal was to hasten the access to a provider. Steps included assessing the patient, performing required diagnostic tests, analyzing drug therapy, initiating new anticoagulation and antiarrhythmic therapies if indicated, and evaluating further follow-up. Table 1¹ highlights the step-by-step process pharmacists followed in this care model.

In the population analyzed, prior to the RAAF model of care evaluation, the median time for patient access to a cardiology physician when diagnosed with AF was 224 days (range, 47-28). After the study was conducted, the median time for a patient’s first appointment with the RAAF clinic was reduced to 14 days, a decrease of 93.75%.¹

Another review of a similar program for anti-arrythmia patients in Australia showed wait times for cardiologist visits decrease from 90 to 10.5 days. These results mimicked a previous study done in Canada, where the initial wait time was reduced from 111 days to 63 days for a reduction of 44%.1^,2

Of 312 patients referred to the Victoria RAAF clinic service, ultimately 274 patients, or 88%, were followed. Forty-seven percent of the patients were female, ranging in age from 49 years and younger to greater than 90 years old, with the majority aged 60 to 79 years. Most patients were referred to the RAAF clinic either from the emergency department or from inpatient hospital wards. Almost all (97%) were seen at least once by a pharmacist, and 91% (248) were seen at least once by a physician. Using standardized evaluation criteria, the median CHADS-VA score was 2.¹

Results

Prior to the RAAF experience, 76% of patients were on rate-controlling medications, and 73% were still on these medications after the clinic experience. Changes occurred mostly in the discontinuation of certain beta blockers and the increase in use of sotalol. Of those with a CHADS-VA score greater than 1, prior to clinic experience, 73% were using anticoagulant drugs; this increased to 88% afterwards.¹

Patient evaluation also factored into the success of the RAAF clinic. When asked, 57% of patients completed follow-up surveys in which they rated the value of their clinic experiences. On a scale of 1 to 10, those responding gave a mean score of 9.1 with respect to their referring another person to the clinic.¹

The general categories of survey questions are listed in Table 2.¹

This retrospective study is yet another indication of the value pharmacists provide with respect to disease state and drug therapy management. In regions where access to health care providers is limited and the demand for skilled clinicians to treat serious illnesses is rising, clinics such as this RAAF facility are essential. They enable patients to receive care promptly and effectively.¹

REFERENCES

1. Livori AC, Kuruppumullage R, Simmons M, et al. Evaluating the implementation of a rapid access atrial fibrillation clinic utilising a pharmacist-physician model of care. Res Social Adm Pharm. 2025;21(7):528-538. doi:10.1016/j.sapharm.2025.03.005

2. Romiti GF, Proietti M, Bonini N, et al. Adherence to the atrial fibrillation better care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry. EClinicalMedicine. 2022;55:101757. doi:10.1016/j.eclinm.2022.101757