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

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.