Effectiveness of pharmacist's intervention in the management of cardiovascular diseases

Abstract

The pharmacist may play a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes. Systematic reviews of randomised controlled and observational studies have documented an improved control of hypertension, dyslipidaemia or diabetes, smoking cessation and reduced hospitalisation in patients with heart failure, following a pharmacist's intervention. Limited proof for effectiveness is available for humanistic (patient satisfaction, adherence and knowledge) and economic outcomes. A multidisciplinary approach, including medical input plus a pharmacist, specialist nurse or both, and a greater involvement of community rather than hospital pharmacists, seems to represent the most efficient and modern healthcare delivery model. However, further well-designed research is demanded in order to quantitatively and qualitatively evaluate the impact of pharmacist's interventions on cardiovascular disease and to identify specific areas of impact of collaborative practice. Such research should particularly focus on the demonstration of a sensitivity to community pharmacist's intervention. Since pharmacy services are easily accessible and widely distributed in the community setting, a maximum benefit should be expected from interventions provided in this context.

Keywords: coronary artery disease; diabetes; heart failure; hypertension; pharmacist.

Figure 1

Difference in changes in SBP and DBP in patients with hypertension after the pharmacist’s intervention versus control. Data are shown as mean difference and 95% CI (redrawn from with permission). DBP, diastolic blood pressure; SBP, systolic blood pressure.

Figure 2

Differences in changes in total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides (expressed as mg/dL) between patients with hyperlipidaemia receiving a pharmacist’s intervention and patients in control groups in a meta-analysis of different studies. Data are shown as mean difference and 95% CI (redrawn from 18 with permission). HDL, high density lipoprotein; LDL, low density lipoprotein.

Figure 3

Effects of pharmacist’s intervention on humanistic, clinical and economic outcomes in patients with cardiovascular disease. CV, cardiovascular.

Figure 4

Education and training route of a clinical pharmacist in a cardiology practice (redrawn from with permission).