Douglas Jennings, PharmD, FCCP, FAHA
Douglas Jennings, PharmD, FCCP, FAHA
Douglas Jennings, PharmD, FCCP, FAHA, FACC, currently practices as the clinical pharmacy manager in heart transplant and mechanical circulatory support at New York Presbyterian Columbia University Medical Center. He is a past chair of the American College of Clinical Pharmacy (ACCP) Cardiology PRN, and he is a fellow of ACCP, the American Heart Association, and the American College of Cardiology.

Community Pharmacists Can Curb Cardiovascular Disease Risk

APRIL 11, 2016
A community pharmacist intervention program reduced the estimated risk for cardiovascular events by 21% in 3 months, according to clinical research presented at ACC.16 in Chicago and simultaneously published in the Journal of the American College of Cardiology.
 
In 2014 and 2015, pharmacists in 56 practices in Alberta identified and randomized 723 adults aged 18 years and older who had diabetes, chronic kidney disease, cerebrovascular disease, cardiovascular disease (CVD), peripheral artery disease, or multiple risk factors and a Framingham risk score >20%. The enrolled patients also had to have at least 1 uncontrolled CVD risk factor (blood pressure >140/90, or >130/80 if diabetic; low-density lipoprotein cholesterol [LDLC] >2.0 mmol/L; HbA1C >7%; or current smoker).
 
The researchers randomized 353 patients to usual care and 370 patients to the community pharmacist intervention. The patients had a mean age of 62 years, 58% were male, and 27% were smokers.
 
Patients in the intervention group received a medication therapy management consultation, in which the pharmacist measured blood pressure, waist circumference, height and weight; ordered laboratory tests to determine HbA1C, lipid levels, and kidney function; and discussed cardiovascular disease risk factors. 

At 3 months, there was a 21% difference in CVD risk between the pharmacist intervention and usual care groups.
 
Greater improvements in the pharmacist intervention group were also seen among all major risk factors:
  • LDLC levels decreased from 2.47 mmol/L to 2.07 mmol/L in the intervention group, compared with 2.34 mmol/L to 2.23 mmol/L in the usual care group.
  • HbA1C decreased from 8.61% to 7.6% in the intervention group, compared with 8.62% to 8.54% in the usual care group.
  • There were 20.2% fewer smokers in the intervention group at the end of the trial.
No adverse events were reported in either group. 
 
The results of this trial must be viewed in the context of a 3-month follow-up period. Furthermore, the study was conducted in Canada, where community pharmacists have an expanded scope of practice compared to their US counterparts. 
 
Nevertheless, these findings illustrate the potential for community pharmacists to go beyond simply dispensing medications to improve the cardiovascular health of patients through direct intervention—a point which is all too salient in light of the worsening shortage of physicians in the United States.
 
Even the research authors asserted that pharmacists with an advanced practice scope could identify patients with poorly controlled risk factors and considerably reduce their risk for cardiovascular events.
 
“As pharmacists are highly accessible primary health care providers, this could have major public health implications in reducing the burden of cardiovascular disease if these practices were widely adopted,” they wrote.

Reference
Tsuyuki RT, Al Hamarneh YN, Jones CA, et al. Effectiveness of community pharmacist prescribing and care on cardiovascular risk reduction: randomized controlled RxEACH trial. J Am Coll Cardiol. 2016; doi: 10.1016/J.JACC.2016.03.528.

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