Interprofessional Guideline to support patients with oral anticoagulation therapy

Atrial fibrillation  (AF), a heart rhythm disorder where the atria beat irregularly and chaotically decreases the heart's blood-pumping efficiency, is the most common sustained heart rhythm disturbance (arrhythmia).  People with AF are three to five times more likely to suffer a devastating, debilitating, disabling and often fatal stroke than people without AF.  Consistently, 20-30% of all strokes are AF related.

The need to create a new Guideline emerged from two key observations. On the one hand, anticoagulation therapy is consistently among the top five reasons for hospital admission, suggesting management of such therapy is suboptimal. On the other hand, there was a need to complement existing guidelines created by well-recognised societies and associations, such as the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC). Greater multidisciplinary vision needed to be incorporated, focusing on the complete patient journey from initiation of therapy to long term management of anticoagulation.

iPACT (International Pharmacists for Anticoagulation Care Taskforce) is an international, multi-disciplinary network of experts that recognizes and supports the importance of optimizing oral anticoagulation management and supports awareness and detection campaigns for undiagnosed fibrillation. Having experience in developing evidence-based guidance to improve patient care and in providing expert education made iPACT an ideal organization to initiate the creation of a new Guideline.

Over 20 experts representing several countries and professions participated in this consensus-seeking process. The new Guideline was created through extensive work, including a Delphi exercise comprised of four internet-based rounds with an international expert panel, as well as face-to-face semi-structured group discussions and two broader consultation rounds of international key opinion leaders and international umbrella organizations.

iPACT made 18 recommendations in the new Guideline, providing the base for optimization of oral anticoagulation care for patients across different countries and health care systems.

The top 5 interprofessional recommendations in the Guideline made to support patients receiving oral anticoagulation therapy were:

  • Transfer of Care between health care settings,
  • Adherence to medication,
  • Patient communication and Engagement and
  • Medication Reconciliation and medication review.

“This Guideline is of paramount importance in providing better care to people living with conditions requiring anticoagulation as part of their journey from initiating anticoagulation to having a long term condition,” says the principal investigator leading this work, Prof. Van Den Bemt, Pharmacist, Senior Researcher and Clinical Pharmacologist, past iPACT Board Member from the Netherlands and current President of the European Society of Clinical Pharmacy (ESCP).

The Guideline is meaningless if not translated into clinical practice

“The fact that iPACT made all possible efforts to include input in the development of this Guideline from recipients of anticoagulation therapy recognizes the importance of involving end-users from early development phases. My views were always welcomed, which is reflective of the collaborative nature of our work. I am certain that this document will be helpful throughout the world, not only for pharmacists, but also for all healthcare professionals,” says Ms. Trudie Lobban, MBE, Founder & CEO, AF Association and Founder & Trustee, Arrhythmia Alliance.

“Of course, the Guideline is meaningless if not translated into clinical practice! We know that from our experience with cardiologists and pharmacists”, says Professor A. John Camm, one of the Key Opinion Leaders consulted, having vast experience in guideline development and implementation.

 “To make implementation possible, we are now developing specific initiatives that are primarily aimed at the recommendations considered to be most relevant by the key stakeholders involved,” says Mr. Sotiris Antoniou, U.K. Consultant Pharmacist and Chair of iPACT and co-author of the guideline. “One example is the Transfer of Care between healthcare settings. This is an area where we are already developing a pilot project, ultimately developing initiatives to improve patient safety.”

Translating this Guideline into multiple languages and ensuring that it is available in all 25 countries represented by iPACT is the next important step. The aim is to collaborate with national societies and global organizations that have special interests in specific areas of the Guideline. For example, the European Society for Patient Adherence, Compliance and Persistence (ESPACOMP) with relevance to adherence, the European Society of Clinical Pharmacy (ESCP) with relevance to medication reconciliation and review, the International Pharmaceutical Federation (FIP) who are advocating for expanding the role of pharmacists.

This international Guideline is an excellent starting point to help guide practice change in our respective countries!

The Guideline calls for governments worldwide to focus on specific domains of anticoagulation care that require interprofessional collaboration. Shared information platforms, which patients can easily access, are one of the pre-requisites for implementing some of the recommendations.

"This international Guideline is an excellent starting point to help guide practice change in our respective countries! We now need to engage our national pharmacy and healthcare leaders to help with the dissemination and application of the Guideline at the primary points of care. Only then will we unlock the potential positive clinical impact," says Prof. Van Den Bemt, President of ESCP, based in The Netherlands. Other ESCP General Committee members share this opinion, and were also involved in the guideline development, namely Dr. Stephane Steurbaut, chair of the most recent ESCP spring workshop devoted to anticoagulation.

Key takeaways

  • The new Guideline aims to improve the quality of life for all of those diagnosed with atrial fibrillation
  • The development of the Guideline was initiated by iPACT, and was the result of multinational and multidisciplinary cooperation
  • There are 18 recommendations in the Guideline
  • The top 5 recommendations are:
    • Transfer of care between health care settings
    • Adherence to medication
    • Patient communication and Engagement
    • Medication Reconciliation and medication review
  • Recommendations need to be translated into clinical practice, for which interprofessional collaboration is essential

How can you make a difference?

Improve your daily practice and make your colleagues AF-aware too by spreading the word to all local pharmacists, family physicians, and nurses! You can do this easily by sending them the short version of the Guideline digitally or in print.

Download and print the one-page summary of the Guideline here or the extended version here.

The full publication where the guideline development is described is available in the International Journal of Clinical Pharmacy and open for download here.

About iPACT (International Pharmacists for Anticoagulation Care Taskforce)

iPACT is a unique international network of anticoagulation experts and individuals who want to improve the care for patients who receive anticoagulation. It recognizes and supports the key role of pharmacists all over the world to optimize oral anticoagulation management. iPACT supports awareness and detection campaigns for undiagnosed fibrillation, develops evidence-based guidance to improve patient care and provides expert education through e-learning, workshops, masterclasses and individualized coaching in your setting.


For enquiries related to professional participation and collaboration:

iPACT (International Pharmacists for Anticoagulation Care Taskforce)

For enquiries related to media, communication and additional materials related to the Guideline:

Lampyon Canada Inc. (Pharma Specialist Marketing and Consulting Agency)

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The European Society of Clinical Pharmacy (ESCP) is an organization that promotes, supports, implements and advances education, practice and research in clinical pharmacy in order to optimize outcomes for patients and society.

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