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Cardiovascular risk screening program in Australian community pharmacies

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Abstract

Objective To assess the suitability of Australian community pharmacies as cardiovascular disease risk profile screening centres and evaluate whether community pharmacists can play an important role in detecting, educating and referring screened individuals at high risk of cardiovascular disease. Setting 14 Australian community pharmacies. Method Opportunistic cardiovascular disease risk profiling for members of the public aged greater than 30 years with no existing cardiovascular diseases was performed. All major cardiovascular risk factors were measured. Exercise habits, existing conditions and therapy, and family history were also assessed. The results were used to calculate each subject’s 10-year risk of developing cardiovascular events, based on Framingham Risk Equations (New Zealand tables). Each subject’s knowledge of cardiovascular risk factors was assessed using a multiple-choice questionnaire. Written educational materials and verbal counselling were provided. Referral to a doctor for further assessment was recommended as appropriate. The screened individuals were followed up via mailed out questionnaire. A random sample of individuals at elevated risk was phoned to assess for outcomes of the screening and referral process. Main outcome measures Risk of developing cardiovascular disease and knowledge of cardiovascular risk factors. Results A total of 655 individuals (71.4% female) were screened for cardiovascular disease risk factors. Ages ranged from 30 to 90 years (median: 54 years) and 14.2% were smokers. Of the individuals screened, 28.1% had a 10-year risk of developing cardiovascular disease greater than 15%, including 6.9% who had a 10-year risk above 30%. The median calculated 10-year risk of developing cardiovascular disease was 9.5%. Approximately one-third of the individuals had elevated blood pressure, and almost two-thirds were either overweight or obese. The mean total serum cholesterol was 5.31 mmol/l, with 40% of individuals having a level above 5.5 mmol/l and 20% having a high-density lipoprotein cholesterol level below 1.0 mmol/l. There was a statistically significant improvement in the knowledge of cardiovascular disease risk factors at follow-up. Almost half of the contacted high-risk subjects reported lifestyle changes or started drug therapy following re-testing by their general practitioner. Conclusion A pharmacy-based cardiovascular disease risk profile screening and education program has the potential to identify and refer many undiagnosed individuals at high risk of cardiovascular events, and help contain the burden of heart disease.

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Acknowledgements

We thank Madeleine Ball, Roger Rumble, Mark Naunton and Sue Owen for their contributions to this work.

Funding

This research was funded by the Australian Government Department of Health and Ageing through the Third Community Pharmacy Agreement Research and Development Program.

Conflicts of interest statement

None to declare

Author information

Authors and Affiliations

  1. Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Locked Bag 26, Hobart, TAS, 7001, Australia

    Gregory M. Peterson, Kimbra D. Fitzmaurice, Helen Kruup & Shane L. Jackson

  2. Pharmacy Discipline, School of Biomedical Sciences, The University of Newcastle, Newcastle, NSW, Australia

    Rohan L. Rasiah

Authors
  1. Gregory M. Peterson
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  2. Kimbra D. Fitzmaurice
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  3. Helen Kruup
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  4. Shane L. Jackson
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  5. Rohan L. Rasiah
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Corresponding author

Correspondence to Gregory M. Peterson.

Appendix: CVD risk factor questionnaire

Appendix: CVD risk factor questionnaire

  1. 1.

    Which of the following is NOT a risk factor for heart disease?

    1. (a)

      smoking

    2. (b)

      high HDL (good) cholesterol level

    3. (c)

      being overweight or obese

    4. (d)

      lack of exercise

  2. 2.

    What percentage of people with heart disease experience no symptoms at all?

    1. (a)

      100%

    2. (b)

      50–60%

    3. (c)

      20–30%

    4. (d)

      0

  3. 3.

    Research studies have shown that people are at a greater risk of heart disease when they have high, uncontrolled levels of:

    1. (a)

      stress

    2. (b)

      depression

    3. (c)

      cholesterol

    4. (d)

      all of the above

  4. 4.

    Which of the following is the best description of coronary artery disease?

    1. (a)

      A chronic disease in which the coronary arteries have hardened and narrowed leaving less room for blood to flow through.

    2. (b)

      A chronic disease in which the coronary arteries have gradually shortened over time, so that they no longer reach the heart.

    3. (c)

      A chronic disease in which fatty cholesterol has softened the coronary arteries causing chest pain.

    4. (d)

      A chronic disease in which high fat foods have eroded the coronary arteries so that the blood is leaking from them and causing chest pain.

  5. 5.

    Smoking is a major risk factor for four of the five leading causes of death including heart attack, stroke, cancer and lung diseases such as emphysema and bronchitis.

    1. (a)

      TRUE

    2. (b)

      FALSE

  6. 6.

    Someone who has smoked for 30–40 years probably will not be able to quit smoking.

    1. a)

      TRUE

    2. b)

      FALSE

  7. (7.

    Diabetes is a condition in which the body either lacks enough insulin or lacks the ability to use insulin properly.

    1. (a)

      TRUE

    2. (b)

      FALSE

  8. 8.

    Diabetics should not eat any sugar:

    1. (a)

      TRUE

    2. (b)

      FALSE

  9. 9.

    Exercise is important for both short-term management and long-term survival in diabetics.

    1. (a)

      TRUE

    2. (b)

      FALSE

  10. 10.

    Exercise can help you do which of the following:

    1. (a)

      lower LDL cholesterol

    2. (b)

      raise HDL cholesterol

    3. (c)

      lower total cholesterol

    4. (d)

      all of the above

  11. 11.

    Which of the following is most likely to increase your LDL (bad) cholesterol level?

    1. (a)

      eating too much cholesterol

    2. (b)

      eating too much saturated fat

    3. (c)

      eating too much unsaturated fat

    4. (d)

      eating too much salt

  12. 12.

    Which of the following is a risk for people with high cholesterol levels?

    1. (a)

      small lumps of fat just under the skin

    2. (b)

      heart attack

    3. (c)

      stroke

    4. (d)

      all of the above

  13. 13.

    High blood cholesterol is one of the risk factors for heart disease that you can do something about.

    1. (a)

      TRUE

    2. (b)

      FALSE

  14. 14.

    To lower your blood cholesterol level you must stop eating meat altogether.

    1. (c)

      TRUE

    2. (d)

      FALSE

  15. 15.

    Cholesterol is only found in animal products.

    1. (a)

      TRUE

    2. (b)

      FALSE

  16. 16.

    Are these foods HIGH or LOW in fat?

    1. (a) toasted muesli

      high/low

    2. (b) pasta

      high/low

    3. (c) rice

      high/low

    4. (d) bread

      high/low

    5. (e) nuts

      high/low

    6. (f) margarine

      high/low

    7. (g) olive oil

      high/low

  17. 17.

    High blood pressure puts additional strain on which of the following body part(s)?

    1. (a)

      heart

    2. (b)

      blood vessels

    3. (c)

      kidneys

    4. (d)

      all of the above

  18. 18.

    Most people get enough physical activity from their normal daily routine.

    1. (a)

      TRUE

    2. (b)

      FALSE

  19. 19.

    People who need to lose some weight are the only ones who will benefit from regular physical activity.

    1. (a)

      TRUE

    2. (b)

      FALSE

  20. 20.

    The older you are, the less active you have to be.

    1. (a)

      TRUE

    2. (b)

      FALSE

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Peterson, G.M., Fitzmaurice, K.D., Kruup, H. et al. Cardiovascular risk screening program in Australian community pharmacies. Pharm World Sci 32, 373–380 (2010). https://doi.org/10.1007/s11096-010-9379-8

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