Intervention by Community Pharmacists Shown to Decrease CV Event Risk
A community pharmacist case-finding and intervention program reduced the estimated risk for cardiovascular events by 21 percent in three months, according to featured clinical research presented on April 4 at ACC.16 in Chicago and simultaneously published in the Journal of the American College of Cardiology.
RxEACH, a multicenter, randomized, controlled trial led by Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC, et al, was conducted in 56 community pharmacies across Alberta, Canada. Patients were randomized in a 1:1 ratio into two groups; one group received intervention care and the other received usual pharmacy/physician care.
Intervention care comprised a standard Medication Therapy Consultation that included a patient assessment (blood pressure, waist circumference and height and weight measurements); lab assessment of HbA1c, lipids and kidney function; individualized cardiovascular disease risk calculation and education about the risk; treatment recommendations, prescription adaptation and prescribing as appropriate to meet treatment targets; and regular follow up every three to four weeks for three months.
The usual care group received typical pharmacy/physician care with no specific interventions or follow up for three months. Patients in this group crossed over into intervention at the end of the three-month period.
Patient inclusion factors were: diabetes, chronic kidney disease, established atherosclerotic vascular disease, or multiple risk scores plus a Framingham risk score higher than 20 percent. Patients were eligible if they had at least one uncontrolled risk factor, including high blood pressure, current smoking, LDL-cholesterol or HbA1c. Both groups started with a baseline cardiovascular risk of about 26 percent.
At the end of the three-month timeline, cardiovascular risk decreased 21 percent in the intervention group. Improvements were seen in all major risk factors. LDL-cholesterol levels decreased from 2.47 mmol/L to 2.07 mmol/L in the intervention group and from 2.34 mmol/L to 2.23 mmol/L in the usual care group. HbA1c results decreased from 8.61 percent to 7.6 percent in the intervention group and 8.62 percent to 8.54 percent in the usual care group. Additionally, there were 20.2 percent fewer smokers in the intervention group at the end of the trial. No adverse events were reported in either group.
The RxEACH Trial's authors assert 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," noted the authors. "This could have major public health implications in reducing the burden of cardiovascular disease if these practices were widely adopted."
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