Effects of pharmacist interventions on cardiovascular risk factors and outcomes: An umbrella review of meta‐analysis of randomized controlled trials

Abstract

Aims To grade the evidence from published meta‐analyses of randomized controlled trials (RCTs) that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes. Methods MEDLINE, Embase, and the Cochrane Library were searched from database inception to July 2021. Meta‐analyses of RCTs were eligible. Quality of evidence were assessed by GRADE approach. Results From 9308 publications, 149 full‐text articles were evaluated for eligibility, and 24 studies with 85 unique meta‐analyses that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes were selected. Overall, 71.7% (61/85) of unique meta‐analyses showed significant impacts of pharmacist intervention. For the quality of evidence, 63.4% of meta‐analyses had large heterogeneity (I2 > 50%) while 1.2, 16.5, 32.9 and 49.4% of meta‐analyses were graded as high, moderate, low and very low quality based on GRADE approach, respectively. Among meta‐analyses with moderate quality, pharmacist interventions significantly mitigated risk factors (including 6/3 mmHg reduction of blood pressure, increased the rate of lipid control, glucose control and smoking cessation (pooled odds ratio, [95% confidence interval] 1.91 [1.55, 2.35], 3.11 [2.3, 4.3] and 2.3 [1.33, 3.97], respectively) and improved medication adherence (1.67 [1.38, 2.02]). Furthermore, pharmacist interventions significantly reduced all‐cause mortality (0.72 [0.58, 0.89]) and improved quality of life in patients suffering from chronic heart failure. Conclusion This umbrella review found convincing evidence that pharmacist intervention can provide a wide range of benefits in cardiovascular disease management, ranging from risk factor control, improvement in medication adherence and, in some settings, reduction in morbidity and mortality.

The participation of clinical pharmacists in the treatment of patients with central nervous system infection can improve the effectiveness and appropriateness of anti-infective treatments: a retrospective cohort study

“…The results of our study showed that the pharmacy services group had a significantly higher rate of treatment improvement and efficiency than the group without pharmacist participation ( p < 0.05). A meta-analysis on cardiovascular disease showed a similar finding: pharmacist services provides a wide range of benefits in cardiovascular disease management, from controlling risk factors to improving medication adherence and, in some settings, reducing morbidity and mortality ( Rattanavipanon et al, 2022 ). No significant effect of the pharmacist services on the cure rate was observed in this study, partly because CNSI have a long course of treatment, making it difficult to achieve the desired treatment outcome during hospitalization, and partly because of our strict cure criteria.…”

The role of Lesotho community pharmacists in preventing and controlling cardiovascular diseases: The perceived facilitators and barriers

“…In a systematic review conducted by Chiazor, Evans [13], community pharmacist's interventions on diabetes and hypertension revealed favourable clinical outcomes [13]. Similar findings reported substantial improvement on hypertension, diabetes, hyperlipidaemias, obesity, and smoking cessation following community pharmacists' interventions [10][11][12]14,15]. The identified roles of community pharmacist suggest that they can provide expanded services and stand an opportunity to improve CVD burden in Lesotho.…”

“…Community pharmacists can provide both effective population-based and individualized primary healthcare services. The effectiveness of community pharmacist' roles in primary healthcare interventions is demonstrated in smoking cessation programs, health promotion, and medication therapy management and adherence services [10][11][12][13][14][15]. Thus, community pharmacy presents an opportunity in primary healthcare setting for effective prevention and control of CVDs.…”

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

“…Recent meta-analyses provide strong evidence for the positive impact of pharmacist interventions on cardiovascular risk factors and outcomes [ 80 ]. The evidence for secondary prevention of stroke from this systematic review is weaker due to the heterogeneity of the studies.…”