The Collaborative Cardiovascular Risk Reduction in Primary Care (CCARP) study

Abstract

Study objective: To evaluate whether a simple pharmacist protocol, consisting of patient screening and cardiovascular risk stratification, identification and reminders about uncontrolled risk factors, and drug adherence support, can significantly reduce cardiovascular risk.

Design: Prospective, randomized, controlled pilot study.

Setting: Large primary care medical clinic in Saskatoon, Saskatchewan, Canada.

Patients: One hundred seventy-six adult patients (mean age 60 yrs) who exhibited a 10-year Framingham risk score of 15% or greater, or a coronary artery disease risk equivalent (coronary artery disease, peripheral artery disease, cerebrovascular disease, or diabetes mellitus).

Intervention: Eligible patients initially met with the pharmacist to receive general counselling about cardiovascular disease and were then randomly assigned to receive ongoing follow-up by the pharmacist (follow-up group [88 patients]) or to return to usual care (single-contact group [88 patients]) for a minimum of 6 months.

Measurements and main results: The primary end point was mean reduction in the 10-year Framingham risk score. Secondary end points included individual modifiable risk factors (systolic and diastolic blood pressures; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], and triglyceride levels; total cholesterol:HDL ratio; and hemoglobin A(1c) value), as well as statin utilization, initiation, and adherence rates. Baseline characteristics were similar across both groups. Neither the mean reduction in 10-year risk (-2.68 for the follow-up group and -1.25 for the single-contact group, one-tailed p=0.098) nor individual risk factors were significantly different between groups. The proportion of patients exhibiting statin adherence of 80% or greater did not significantly differ between groups at study end (73.1% [57/78] and 80.0% [52/65], respectively, p=0.333). However, 85.2% (75/88) in the follow-up group continued with statin therapy at the end of the study compared with 67.0% (59/88) in the single-contact group (p=0.005). Statin initiations were more frequent in the follow-up group than in the single-contact group (75.0% [30/40) vs 48.9% [22/45], p=0.013).

Conclusion: This simple cardiovascular care protocol for nonspecialist pharmacists did not result in a clear improvement to cardiovascular risk reduction success among patients in a primary care medical clinic. The intervention did, however, appear to improve statin utilization.