RxEACH: Pharmacist care reduces risk for CVD events, individual CV risk factors

CHICAGO — A case-finding and intervention program initiated by pharmacists reduces the risk for CV events, as well improve individual CV risk factors, researchers reported at the American College of Cardiology Scientific Session.

“Numerous trials have evaluated the benefit of pharmacist care on individual risk factors, but not altogether in one province-wide program,” Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC, Professor of Medicine (Cardiology) at the University of Alberta, said in a presentation.

Tsuyuki and colleagues enrolled 56 community pharmacies across Alberta, Canada, to evaluate the effect pharmacist-led intervention had on CV risk. For the RxEACH study, the pharmacists recruited 723 adults (mean age, 62 years) who had at least one uncontrolled CV risk factor and randomly assigned them into an intervention (n = 370) or usual-care group (n = 353).

In the intervention group, pharmacists conducted a medication therapy management review (including CVD risk assessment and education), prescribed medicine and ordered laboratory tests. Participants in the intervention group also received monthly follow-up visits for 3 months. The usual care group received usual care from their pharmacist and physician.

The primary endpoint was the difference in change in estimated risk for CV events between intervention and usual-care groups at 3 months. Secondary endpoints included the difference in change in individual CV risk factors (systolic and diastolic BP, LDL level, HbA1c level and smoking cessation) between the intervention and usual-care groups at 3 months. The results were simultaneously published in the Journal of the American College of Cardiology.

At baseline, the estimated CV risk was 26.6% in the usual-care group and 25.6% in the intervention group. At the end of the 3-month follow-up, those participants in the usual-care group had an estimated CV risk of 25.9% vs. 20.5% in the intervention group. After adjusting for center effect, this translates to a relative decrease of 21% (P < .001) in estimated CV risk in 3 months, according to the researchers.

The researchers also observed differences in LDL-c (–0.2 mmol/L; P = .001), systolic BP (–9.37 mm Hg; P < .001) and HbA1c (in diabetics only, –0.92%; P < .001). There was a 20.2% greater reduction in smoking in the intervention group (P = .002).

“This … represents a new paradigm in community-based CV reduction,” Tsuyuki said. “It is complementary to, and in collaboration with, physician care with a high degree of patient satisfaction.

“If you were serious about CV risk reduction, in the U.S. and Canada about 450,000 pharmacists are available to help you in the fight against CVD,” he said. – by Tracey Romero

References:

Tsuyuki R, et. al. Featured Clinical Research II. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Tsuyuki R, et al. J Am Coll Cardiol. 2016; doi:10.1016/j.jacc.2016.03.528.

Disclosure: Tsuyuki reports receiving funding from AstraZeneca, Merck and Sanofi, and consultant fees from Merck.