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A Cross-Sectional Survey of Knowledge, Confidence, and Decision-Making in Acute Stroke in the Era of Anti-Amyloid Therapies
Sarangarm P, Acquisto NM, Zimmerman DE, Keric A, Kroll C, Faine B, Rech MA, EMPHARM‐NET.. Journal of the American College of Clinical Pharmacy : JACCP, 2026-10-01
Topic: Amyloid, tau and blood-test diagnosis
Background Anti-amyloid therapies (AATs) for Alzheimer's disease complicate emergency stroke care due to the risk of amyloid-related imaging abnormalities (ARIA), which can mimic acute ischemic stroke (AIS) and increase hemorrhagic risk. We evaluated emergency medicine (EM) providers' (physicians and advanced practice providers) and pharmacists' knowledge, confidence, and clinical decision-making related to AAT-associated ARIA. Methods A cross-sectional, web-based survey of EM providers and pharmacists practicing in United States hospital-based emergency care settings between February and April 2026 was conducted. Survey domains included familiarity with AATs, confidence in ARIA recognition and management, clinical decision-making, institutional preparedness, and barriers and facilitators to care. Results are reported descriptively, with subgroup comparisons between EM providers and pharmacists. Results Clinical experience with AAT-related scenarios was limited among the 204 survey participants; 77.5% reported no prior modification of thrombolytic or anticoagulant therapy because of AATs. Self-reported knowledge of AATs was low (mean 2.4 ± 1.3 on a five-point scale), and confidence in recognizing and managing ARIA was limited. EM pharmacists reported greater knowledge and higher confidence in medication-related decision-making than EM providers. Frequent barriers were unfamiliarity with AAT and ARIA, diagnostic overlap with acute ischemic stroke, and limited institutional resources. Most (83.3%) reported a need for additional education. Conclusions EM providers and pharmacists demonstrated substantial gaps in preparedness for patients receiving AATs, including limited knowledge, low confidence, minimal clinical experience, and inadequate institutional support. These findings highlight opportunities for pharmacist-led education, clinical decision support, and multidisciplinary implementation strategies to improve safe management of AAT-associated neurologic emergencies as therapies continue to expand.
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APA 7th
Sarangarm, P., Acquisto, N. M., Zimmerman, D. E., Keric, A., Kroll, C., Faine, B., et al. (2026). A Cross-Sectional Survey of Knowledge, Confidence, and Decision-Making in Acute Stroke in the Era of Anti-Amyloid Therapies. Journal of the American College of Clinical Pharmacy : JACCP. https://doi.org/10.1002/jac5.70291
Vancouver
Sarangarm P, Acquisto NM, Zimmerman DE, Keric A, Kroll C, Faine B, et al. A Cross-Sectional Survey of Knowledge, Confidence, and Decision-Making in Acute Stroke in the Era of Anti-Amyloid Therapies. Journal of the American College of Clinical Pharmacy : JACCP. 2026. doi:10.1002/jac5.70291. PMID: 42723327.
BibTeX
@article{sarangarm2026-42723327,
author = {Sarangarm, P. and Acquisto, N. M. and Zimmerman, D. E. and Keric, A. and Kroll, C. and Faine, B. and Rech, M. A. and EMPHARM‐NET},
title = {{A Cross-Sectional Survey of Knowledge, Confidence, and Decision-Making in Acute Stroke in the Era of Anti-Amyloid Therapies}},
journal = {Journal of the American College of Clinical Pharmacy : JACCP},
year = {2026},
doi = {10.1002/jac5.70291},
pmid = {42723327},
url = {https://doi.org/10.1002/jac5.70291}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Results are reported descriptively, with subgroup comparisons between EM providers and pharmacists.
- Results Clinical experience with AAT-related scenarios was limited among the 204 survey participants; 77.5% reported no prior modification of thrombolytic or anticoagulant therapy because of AATs.
- Conclusions EM providers and pharmacists demonstrated substantial gaps in preparedness for patients receiving AATs, including limited knowledge, low confidence, minimal clinical experience, and inadequate institutional support.
- These findings highlight opportunities for pharmacist-led education, clinical decision support, and multidisciplinary implementation strategies to improve safe management of AAT-associated neurologic emergencies as therapies continue to expand.
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Study details
- Study designcross-sectional
- Effect size77.5%; 83.3%
- Evidence strengthLow
How this study scored 53/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 31 of the 58 points we could judge it on, which is 53 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American College of Clinical Pharmacy : JACCP) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42723327) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 31 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 31 of the 58 points we could judge it on is 53 out of 100. |
| Total | 53 / 100 | — |
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