The critical role of cardiology and anticoagulation pharmacists in strengthening cardiovascular care in Canada

HN Summary

• Cardiology and anticoagulation pharmacists improve patient safety and outcomes, reducing complications and hospital readmissions. 

• They play a key role in managing complex, high-risk medications and rising cardiovascular costs through evidence-based care. 

• Their work enhances efficiency, access, and system sustainability in Canada’s growing cardiovascular care demands.

Cardiology and anticoagulation pharmacists play a vital role in strengthening Canada’s health care system by improving medication safety, optimizing cardiovascular therapy, reducing preventable hospitalizations, and helping manage the substantial costs associated with cardiovascular disease (CVD). CVD remains one of Canada’s leading causes of death and health system utilization, responsible for nearly one in five deaths nationwide and accounting for millions of hospitalizations over the past decade. As cardiovascular care becomes increasingly complex—driven by aging populations, multimorbidity, and expanding pharmacotherapy options—cardiology pharmacists are essential to delivering high-quality, sustainable care.

Addressing the cost and complexity of cardiovascular disease

Cardiovascular disease imposes a significant and growing economic burden on the Canadian health care system. Canadians spend billions of dollars annually on cardiovascular medications, with expenditures exceeding $5 billion as early as 2006 and continuing to rise as newer, higher cost therapies become more widely used. National health spending is projected to reach $399 billion in 2025, with prescription drugs accounting for nearly 14% of total health expenditures.

Medication mismanagement in cardiovascular disease—particularly anticoagulants—remains a major driver of preventable harm and cost. Anticoagulants are consistently identified as high alert medications due to their narrow therapeutic window and association with serious bleeding events. Hospitalizations related to heart conditions frequently involve medication related issues, with 40% of patients readmitted following an initial cardiovascular hospitalization. Cardiology pharmacists directly mitigate these risks through evidence-based prescribing, close monitoring, and proactive patient education.

Improving outcomes through pharmacist led cardiovascular care

Pharmacist-led cardiology and anticoagulation services have demonstrated clear benefits for patients and the health system. Canadian studies show that pharmacist managed anticoagulation clinics achieve exceptional quality, with time in therapeutic range (TTR) exceeding 74%, well above thresholds associated with reduced stroke and bleeding risk. These outcomes represent some of the highest quality warfarin management data reported in Canadian clinical practice. 

In outpatient and inpatient settings alike, pharmacist-led anticoagulation services are associated with fewer bleeding complications, reduced hospital admissions, and improved adherence to guideline recommended therapy. Canadian evaluations of pharmacist led direct oral anticoagulant (DOAC) monitoring clinics further demonstrate safe use, appropriate laboratory monitoring, and early identification of medication related problems before they escalate into adverse events.

Beyond anticoagulation, cardiology pharmacists contribute to optimized management of heart failure, atrial fibrillation, ischemic heart disease, and hypertension—conditions responsible for a substantial proportion of emergency visits and inpatient bed use nationwide. By ensuring appropriate medication selection, titration, and continuity across care transitions, pharmacists help reduce avoidable readmissions and improve long-term cardiovascular outcomes.

Enhancing efficiency, access, and patient experience

Cardiology pharmacists also expand system capacity by allowing cardiologists and primary care providers to focus on diagnostic and procedural care while pharmacists manage complex medication regimens. Pharmacist-led services improve care coordination, particularly for patients with polypharmacy, renal impairment, or fluctuating clinical status. Patients benefit from increased access to medication expertise, clear education on high-risk therapies, and personalized support—key factors in adherence and self-management for chronic cardiovascular conditions.

From a system perspective, pharmacist involvement supports cost-effective prescribing, deprescribing when appropriate, and alignment with national clinical guidelines. As Canada faces tightening health care budgets and workforce constraints, cardiology pharmacists represent a high value, scalable solution to rising cardiovascular demand.

Leadership in practice: Ava Azhir, BSc. (Pharm), ACPR, PharmD, BCACP

Leadership in cardiology and anticoagulation pharmacy is exemplified by Ava Azhir, Lead of the Anticoagulation Management Clinic at the Jim Pattison Outpatient and Surgery Care Centre in Surrey, British Columbia. 

In this role, Ava provides specialized care for patients requiring anticoagulation therapy and supports the safe, evidence-informed use of complex medications

Ava also serves as Chair of CSHP’s Anticoagulation / Cardiology Community of Practice, a national forum connecting pharmacists across acute care, ambulatory clinics, and integrated community models. The community facilitates shared learning on evolving evidence, anticoagulation safety, and cardiovascular pharmacotherapy optimization. 

“Being part of this Community of Practice has transformed professional isolation into collective purpose. It has been both an anchor and a catalyst for my practice — grounding my clinical work in shared standards while continually challenging me to grow as a clinician, educator, and leader.” Ava then adds, “Through collaboration and mentorship, this community supports stewardship, sustains expertise, and turns individual knowledge into shared impact for patients.”

A vital role in a high burden disease area

As cardiovascular disease continues to drive morbidity, mortality, and health care spending in Canada, cardiology and anticoagulation pharmacists are indispensable members of the care team. Their contributions improve safety, enhance efficiency, and support sustainable use of health system resources—while delivering meaningful benefits to patients living with chronic cardiovascular conditions.

By combining clinical expertise, system stewardship, and national leadership through organizations like CSHP, cardiology pharmacists are uniquely positioned to help Canada meet the growing demands of cardiovascular care with quality, value, and resilience.

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