A Cross‐Sectional Survey of Knowledge, Confidence, and Decision‐Making in Acute Stroke in the Era of Anti‐Amyloid Therapies

ABSTRACT 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.