Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Abstract

Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist‐prescribed medication and drug use by the patient, drug‐related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist–provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist–provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8‐item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36‐Short Form Health Survey (SF‐36), heart rate, systolic and diastolic blood pressure, low‐density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: −100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs −14.58, P = 0.0001), knowledge score (median: 30.28 vs −5.196, P = 0.0001), SF‐36 scores, heart rate (mean: −10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: −17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: −16.22 vs 4.751, P = 0.0001), LDL (median: −25.73 vs −0.2538, P = 0.0071), TC (median: −14.62 vs 4.123, P = 0.0005) and FBG (median: −11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.

A importância da assistência farmacêutica nos problemas relacionados à medicamentos: uma revisão integrativa

“…Foram feitas 138 intervenções no grupo teste, indicado como controlar os efeitos colaterais dos fármacos (44,2%), adição de medicamentos (20,2%), suspensão de medicamentos (8%), substituição de medicamentos (14 %) e ajuste de dose (14%), tendo uma aceitação de 96,2%. As classes mais relacionadas com os PRMs, em ambos os grupos, teste e controle, foram: Beta-bloqueadores (21,9%), estatinas (17,3%) e IECA/ARBs (15,3%) (Casper et al, 2019).…”

“…Os PRMs podem serem resultantes das etapas que envolvem o processo terapêutico, como a prescrição, dispensação e administração, mas também do efeito nocivo que pode ser esperado no tratamento. A ocorrência dos PRMs, prejudica a farmacoterapia e podem causar danos aos pacientes (Nascimento et al, 2020), esse resultado diferente do que é almejado na terapêutica, provoca consultas extras e hospitalizações, o que colabora com o aumento nos custos de saúde (Casper et al, 2019). Os efeitos nocivos ao paciente desenvolvido da terapia, constitui as reações adversas a medicamentos ou erros de medicação (EM), caracterizando os PRMs (Aguiar et al, 2018).…”

Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist

“…A retrospective study showed that MDT-based cardiac rehabilitation with clinical pharmacist involvement improved adherence to ACE inhibitors and beta-blocker therapy and decreased rates of readmission [41]. Furthermore, clinical pharmacist involvement in cardiac rehabilitation was associated with a reduction in drug-related problems in a randomized trial, as well as improvements in medication adherence, patient knowledge regarding secondary prevention of ACS, and health-related quality of life [42]. Similarly, in a prospective real-world study, hospital-based rehabilitation with clinical pharmacist involvement led to improvements in physical and mental health at 1-year post-discharge [43].…”

Adesão Ao Exame Colpocitológico Em Mulheres Idosas Revisão Bibliográfica

“…Deste modo, promover a educação em saúde do paciente e propor intervenções sobre regimes terapêuticos ao serem conduzidas por farmacêuticos se apresentam como boas estratégias para a melhoria da efetividade do tratamento e para redução de discrepâncias medicamentosas, sendo assim implementadas na prática clínica visando-se à otimização e racionalização da farmacoterapia e à segurança do paciente (RAVN-NIELSEN et al, 2018;BRANCO et al, 2019;CASPER et al, 2019;RODRIGUES et al, 2019).…”