Pharmacist-Led Interventions for the Management of Cardiovascular Disease: Opportunities and Obstacles
Karen J. McConnell
Anne M. Denham
Kari L. Olson
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.
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