Abstract
Given the documented treatment gap for patients with cardiovascular disease, there are numerous opportunities for pharmacists to become more extensively involved in the delivery of care to these high-risk patients.
In published trials, pharmacists have demonstrated improved surrogate outcomes for patients with cardiovascular disease by managing hyperlipidemia, hypertension, and secondary prevention medications. A concentrated effort by pharmacists in the inpatient setting, using a combination of direct provider and patient interventions, has been shown to improve adherence to evidence-based guidelines and to help optimize patient care outcomes for acute coronary syndromes. In ambulatory care, there are numerous examples of how pharmacists can help optimize medication regimens for cardiovascular disease and cardiovascular risk factor control. Community pharmacists have been successful in helping treat hyperlipidemia in patients with cardiovascular disease. While these studies have demonstrated that pharmacy-based interventions improve surrogate outcomes, there are limited well designed, randomized, controlled trials that have demonstrated that pharmacist-managed interventions improve clinical or humanistic outcomes in patients with cardiovascular disease or that such programs are cost effective.
Opportunities for pharmacists exist at each stage of cardiovascular disease management. A needs assessment should be performed to determine the level of risk factor control and appropriate medication utilization within an organization, institution, or practice site. Physician support and collaboration among multidisciplinary teams are essential to the success of the service. Potential funding sources for establishing a service should be researched, and justification for the investment must be made. Limited time and compensation are likely to be the greatest obstacles to pharmacists instituting cardiovascular services. Other key elements include employing well trained, experienced staff, utilizing a medication protocol and patient tracking database, and implementing safety measures. An opportunity exists to conduct rigorous, well designed studies to evaluate the outcomes of pharmacist-led interventions for patients with cardiovascular disease.
Similar content being viewed by others
References
American Heart Association. Heart disease and stroke statistics: 2008 [online]. Available from URL: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.187998 [Accessed 2008 Feb 20]
World Health Organization. Major causes of death: a primer [online]. Available from URL: http://www.who.int/mediacentre/factsheets/fs310/en/index2.html [Accessed 2007 Oct 29]
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction). Developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 2007 Aug 14; 116(7): e148–304
Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation 2004 Aug 31; 110(9): e82–292
Krumholz HM, Anderson JL, Brooks NH, et al. ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (writing committee to develop performance measures on ST-elevation and non-ST-elevation myocardial infarction). Circulation 2006 Feb 7; 113(5): 732–61
Smith Jr SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006 May 16; 113(19): 2363–72
Bhatt DL, Steg PG, Ohman EM, et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006 Jan 11; 295(2): 180–9
Qureshi AI, Suri MF, Guterman LR, et al. Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2001 Jul 9; 161(13): 1621–8
Califf RM, DeLong ER, Ostbye T, et al. Underuse of aspirin in a referral population with documented coronary artery disease. Am J Cardiol 2002 Mar 15; 89(6): 653–61
Stafford RS, Radley DC. The underutilization of cardiac medications of proven benefit, 1990 to 2002. J Am Coll Cardiol 2003 Jan 1; 41(1): 56–61
Stringer KA, Lopez L, Talbert RL. A call for pharmacists to improve the care of patients with myocardial infarction. Pharmacotherapy 2001 Nov; 21(11): 1317–9
Pharmaceutical Services Negotiating Committee, National Pharmaceutical Association, Royal Pharmaceutical Society of Great Britian, Pharmacy Health Link. Public health: a practical guide for community pharmacists. London: Ushers Print and Design, 2006
Tsuyuki RT, Semchuk W, Poirier L. 2006 Canadian hypertension education program for the management of hypertension by pharmacists. Can Pharm J 2006; 139 Suppl. 1: 11–3
Chapman NR, Fotis MA, Yarnold PR, et al. Pharmacist interventions to improve the management of coronary artery disease. Am J Health Syst Pharm 2004 Dec 15; 61(24): 2672–8
Bailey TC, Noirot LA, Blickensderfer A, et al. An intervention to improve secondary prevention of coronary heart disease. Arch Intern Med 2007 Mar 26; 167(6): 586–90
Scott IA, Denaro CP, Bennett CJ, et al. Achieving better in-hospital and after-hospital care of patients with acute cardiac disease. Med J Aust 2004 May 17; 180(10 Suppl.): S83–8
O’Dell KM, Kucukarslan SN. Impact of the clinical pharmacist on readmission in patients with acute coronary syndrome. Ann Pharmacother 2005 Sep; 39(9): 1423–7
Coons JC, Fera T. Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure. Am J Health Syst Pharm 2007 Jun; 64(12): 1274–8
Axtell SS, Ludwig E, Lope-Candales P. Intervention to improve adherence to ACC/AHA recommended adjunctive medications for the management of patients with an acute myocardial infarction. Clin Cardiol 2001 Feb; 24(2): 114–8
Donovan JL, Schroeder WS, Tran MT, et al. Assessment of eptifibatide dosing in renal impairment before and after in-service education provided by pharmacists. J Manag Care Pharm 2007 Sep; 13(7): 598–606
Bozovich M, Rubino CM, Edmunds J. Effect of a clinical pharmacist-managed lipid clinic on achieving National Cholesterol Education Program low-density lipoprotein goals. Pharmacotherapy 2000 Nov; 20(11): 1375–83
Faulkner MA, Wadibia EC, Lucas BD, et al. Impact of pharmacy counseling on compliance and effectiveness of combination lipid-lowering therapy in patients undergoing coronary artery revascularization: a randomized, controlled trial. Pharmacotherapy 2000 Apr; 20(4): 410–6
Merenich JA, Lousberg TR, Brennan SH, et al. Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (the Rocky Mountain Kaiser Permanente experience). Am J Cardiol 2000 Feb 10; 85(3A): 36A–42A
DiTusa L, Luzier AB, Brady PG, et al. A pharmacy-based approach to cholesterol management. Am J Manag Care 2001 Oct; 7(10): 973–9
Hilleman DE, Monaghan MS, Ashby CL, et al. Physician-prompting statin therapy intervention improves outcomes in patients with coronary heart disease. Pharmacotherapy 2001 Nov; 21(11): 1415–21
Geber J, Parra D, Beckey NP, et al. Optimizing drug therapy in patients with cardiovascular disease: the impact of pharmacist-managed pharmacotherapy clinics in a primary care setting. Pharmacotherapy 2002 Jun; 22(6): 738–47
Olson KL, Rasmussen J, Sandhoff BG, et al. Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization. Arch Intern Med 2005 Jan 10; 165(1): 49–54
Straka RJ, Taheri R, Cooper SL, et al. Achieving cholesterol target in a managed care organization (ACTION) trial. Pharmacotherapy 2005 Mar; 25(3): 360–71
Reilly V, Cavanagh M. The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist. Pharm World Sci 2003 Dec; 25(6): 294–8
Kammer RT. Pharmacist’s role in a cardiac rehabilitation program. Am J Health Syst Pharm 2004 Aug 1; 61(15): 1593–5
Merenich JA, Olson KL, Delate T, et al. Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease. Pharmacotherapy 2007 Oct; 27(10): 1370–8
McConnell KJ, Zadvorny EB, Hardy AM, et al. Coronary artery disease and hypertension: outcomes of a pharmacist-managed blood pressure program. Pharmacotherapy 2006 Sep; 26(9): 1333–41
McConnell KJ, Zadvorny EB, Denham AM, et al. Angiotensin-converting enzyme inhibitor therapy for coronary artery disease and diabetes mellitus. Am J Manag Care 2007 Oct; 13(10): 560–6
Retiring TF, Stolcpart RS, Sandhoff BG, et al. Effect of a clinical pharmacy service on lipid control in patients with peripheral arterial disease. J Vasc Surg 2006 Jun; 43(6): 1205–10
Sandhoff BG, Nies LK, Olson KL, et al. Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization. Am J Health Syst Pharm 2007 Jan 1; 64(1): 77–84
Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 2002 May 27; 162(10): 1149–55
Tsuyuki RT, Olson KL, Dubyk AM. Effect of community pharmacist intervention on cholesterol levels in patients at high risk of cardiovascular events: the Second Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP-plus). Am J Med 2004 Jan 15; 116(2): 130–3
Peterson GM, Fitzmaurice KD, Naunton M, et al. Impact of pharmacist-conducted home visits on the outcomes of lipid-lowering drug therapy. J Clin Pharm Ther 2004 Feb; 29(1): 23–30
The MEDMAN study: a randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease. Fam Pract 2007 Apr; 24 (2): 189-200
Fagan SC, Touchette D, Smith JA, et al. The state of science and research in clinical pharmacy. Pharmacotherapy 2006 Jul; 26(7): 1027–40
Harris IM, Baker E, Berry TM, et al. Developing a business-practice model for pharmacy services in ambulatory settings. Pharmacotherapy 2008 Feb; 28(2): 7e–34e
National Committee for Quality Assurance. Quality compass 2007. Washington, DC: National Committee for Quality Assurance, 2007
Joint Commission on Accreditation of Healthcare Organizations. Joint commission requirements [online]. Available from URL: http://www.jointcommission.org/Standards/Requirements. [Accessed 2007 Oct 29]
World Medical Organization. Statement on the working relationship between physicians and pharmacists in medicinal therapy [online]. Available from URL: http://www.wma.net/e/policy/m33htn. [Accessed 2007 Oct 23]
Keely JL. Pharmacist scope of practice. Ann Intern Med 2002 Jan 1; 136(1): 79–85
Hammond RW, Schwartz AH, Campbell MJ, et al. Collaborative drug therapy management by pharmacists: 2003. Pharmacotherapy 2003 Sep; 23(9): 1210–25
Kuo GM, Buckley TE, Fitzsimmons DS, et al. Collaborative drug therapy management services and reimbursement in a family medicine clinic. Am J Health Syst Pharm 2004 Feb 15; 61(4): 343–54
Emmerton L, Marriott J, Bessell T, et al. Pharmacists and prescribing rights: review of international developments. J Pharm Pharmaceut Sci 2005; 8(2): 217–25
Hughes CM, McCann S. Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment. Br J Gen Pract 2003 Aug; 53(493): 600–6
Doucette WR, Nevins J, McDonough RP. Factors affecting collaborative care between pharmacists and physicians. Res Social Adm Pharm 2005 Dec; 1(4): 565–78
Zillich AJ, McDonough RP, Carter BL, et al. Influential characteristics of physician/pharmacist collaborative relationships. Ann Pharmacother 2004 May; 38(5): 764–70
Howard M, Trim K, Woodward C, et al. Collaboration between community pharmacists and family physicians: lessons learned from the Seniors Medication Assessment Research Trial. J Am Pharm Assoc 2003 Sep; 43(5): 566–72
Epplen K, Dusing-Wiest M, Freedlund J, et al. Stepwise approach to implementing ambulatory clinical pharmacy services. Am J Health Syst Pharm 2007 May 1; 64(9): 945–51
Okamoto MP, Nakahiro RK. Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic. Pharmacotherapy 2001 Nov; 21(11): 1337–44
Hilleman DE, Faulkner MA, Monaghan MS. Cost of a pharmacist-directed intervention to increase treatment of hypercholesterolemia. Pharmacotherapy 2004 Aug; 24(8): 1077–83
Schumock GT, Butler MG, Meek PD, et al. Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Pharmacotherapy 2003 Jan; 23(1): 113–32
Vora S, Cohen T. Implementing clinical services across a large health system. Am J Health Syst Pharm 2007 Mar 1; 64(5): 460, 463
Martin-Calero MJ, Machuca M, Murillo MD, et al. Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des 2004; 10(31): 3969–85
Simpson SH, Johnson JA, Biggs C, et al. Practice-based research: lessons from community pharmacist participants. Pharmacotherapy 2001 Jun; 21(6): 731–9
Jones EJ, Mackinnon NJ, Tsuyuki RT. Pharmaceutical care in community pharmacies: practice and research in Canada. Ann Pharmacother 2005 Sep; 39(9): 1527–33
Snella KA, Trewyn RR, Hansen LB, et al. Pharmacist compensation for cognitive services: focus on the physician office and community pharmacy. Pharmacotherapy 2004 Mar; 24(3): 372–88
Christensen DB, Farris KB. Pharmaceutical care in community pharmacies: practice and research in the US. Ann Pharmacother 2006 Jul; 40(7–8): 1400–6
Farris KB, Kumbera P, Halterman T, et al. Outcomes-based pharmacist reimbursement: reimbursing pharmacists for cognitive services. Part 1. J Manag Care Pharm 2002 Sep; 8(5): 383–93
Suh DC. Consumer’s willingness to pay for pharmacy services that reduce risk of medication-related problems. J Am Pharm Assoc (Wash.) 2000 Nov; 40(6): 818–27
Barner JC, Branvold A. Patients’ willingness to pay for pharmacist-provided menopause and hormone replacement therapy consultations. Res Social Adm Pharm 2005 Mar; 1(1): 77–100
Helling DK, Nelson KM, Ramirez JE, et al. Kaiser Permanente Colorado Region Pharmacy Department: innovative leader in pharmacy practice. J Am Pharm Assoc (2003) 2006 Jan; 46(1): 67–76
National Community Pharmacist Association [online]. Available from URL: http://www.ncpanet.org/nipco/programs/ [Accessed 2007 Nov 7]
National Lipid Association [online]. Available from URL: http://www.pharmacist.com/Content/NavigationMenu3/ContinuingEducation/Cert ificateTrainingProgram/PharmacyBasedLipidManagement/Pharma_Lipid_Mg mt.htm [Accessed 2007 Nov 7]
American Pharmacists Association. Pharmacist-based lipid management [online]. Available from URL: http://www.ashpfoundation.org/MainMenuCategories/Education/Traineeships/CardiovascularTraineeship.aspx [Accessed 2007 Nov V]
ASHP Foundation. Cardiovascular risk/dyslipidemia traineeship [online]. Available from URL: http://www.ashpfoundation.org/MainMenuCategories/Educa tion/Traineeships/CardiovascularTraineeship.aspx [Accessed 2007 Nov 7]
Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001 May 16; 285 (19): 2486-97
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003 Dec; 42(6): 1206–52
Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007 Sep; 14 Suppl. 2: E1–40
Mancia G, De BG, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007 Jun; 25(6): 1105–87
Khan NA, Hemmelgarn B, Padwal R, et al. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2. Therapy. Can J Cardiol 2007 May 15; 23(7): 539–50
Holsclaw SL, Olson KL, Hornak R, et al. Assessment of patient satisfaction with telephone and mail interventions provided by a clinical pharmacy cardiac risk reduction service. J Manag Care Pharm 2005 Jun; 11(5): 403–9
Collins C, Kramer A, O’Day ME. Evaluation of patient and provider satisfaction with a pharmacist-managed lipid clinic in a Veterans Affairs medical center. Am J Health Syst Pharm 2006 Sep 15; 63(18): 1723–7
Nola KM, Gourley DR, Portner TS, et al. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. J Am Pharm Assoc (Wash.) 2000 Mar; 40(2): 166–73
Acknowledgments
No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McConnell, K.J., Denham, A.M. & Olson, K.L. Pharmacist-Led Interventions for the Management of Cardiovascular Disease. Dis-Manage-Health-Outcomes 16, 131–144 (2008). https://doi.org/10.2165/00115677-200816030-00001
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-200816030-00001