Engaging Community Pharmacists to Lower Cardiovascular Risk

Apr 04, 2016
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Authors:
Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgran BR.
Citation:
Effectiveness of Community Pharmacist Prescribing and Care on Cardiovascular Risk Reduction: Randomized Controlled RxEACH Trial. J Am Coll Cardiol 2016;Apr 4:[Epub ahead of print].
Summary By:
Prashant Vaishnava, MD, FACC; ; ; Helmut Drexler, MD; Pedro Graziano, MD; ; Lee A. Fleisher, MD, FACC; Enrico Fabris, MD; Douglas M. Richter, MD, FACC; Rabia Rafi Razi, MD, MPH; Khaled Imad Khalaf, MD, FACC

Study Questions:

What is the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular disease (CVD) risk reduction?



Methods:

The RxEACH study was a multicenter, randomized, controlled trial conducted in 56 community pharmacies in Alberta, Canada. Eligible adults were those at high risk for CV events because of known diabetes, chronic kidney disease, established atherosclerotic disease, or Framingham risk score >20%. Eligible patients also had one uncontrolled risk factor (e.g., current smoker). Patients were randomized 1:1 to usual care or an intervention group in which they received a Medication Therapy Management consultation. This consultation included prescription adaptation(s) and/or de novo prescriptions where necessary, and regular follow-up every 3-4 weeks for 3 months. The primary outcome was difference in estimated CV risk between intervention and usual care groups at 3 months. Secondary outcomes included the difference in change in individual CV risk factors (systolic and diastolic blood pressure, low-density lipoprotein cholesterol [LDL-C], glycated hemoglobin [HbA1c], and smoking cessation).

Results:

A total of 723 patients were randomized. In adjusted analyses, there was a 21% difference in estimated CVD risk (p < 0.001) between intervention and usual care groups. The intervention group had greater reductions of 0.2 mmol/L in LDL-C (p < 0.001), 9.37 mm Hg systolic blood pressure (p < 0.001), 0.92% HbA1c (p < 0.001), and 20.2% in smoking cessation (p = 0.002).

Conclusions:

A community pharmacy-based case finding and intervention was successful in reducing estimated risk for CVD events and individual CV risk factors.

Perspective:

This is a valuable study that demonstrates the potential role of engagement of community pharmacists in improving risk for adverse CV events and lowering CV risk in populations with established CV risk or at significantly escalated risk. Such innovative strategies are important to consider as CVD is the dominant cause of mortality worldwide, and group-based collaborative approaches that leverage the abilities of multiple team members may be particularly effective in some settings.

Keywords: ACC Annual Scientific Session, Atherosclerosis, Blood Pressure, Cardiovascular Diseases, Cholesterol, LDL, Diabetes Mellitus, Glycated Hemoglobin A, Medication Therapy Management, Pharmacists, Primary Prevention, Referral and Consultation, Renal Insufficiency, Chronic, Risk Factors, Risk Reduction Behavior, Smoking Cessation


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