The Effectiveness of Pharmacist Interventions on Cardiovascular Risk

Tsuyuki, Ross T.; Hamarneh, Yazid N. Al; Jones, Charlotte; Hemmelgarn, Brenda R.

doi:10.1016/j.jacc.2016.03.528

Cited by 166 publications

(175 citation statements)

References 29 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…37,38 There is also emerging evidence that primary care and community-based pharmacy interventions are effective in reducing the risk of cardiovascular outcomes. 39,40 Thus, novel approaches to stroke prevention, potentially embedded in community or primary care, may be an effective alternative to specialty follow-up for long-term management in this high-risk population.…”

Section: Discussionmentioning

confidence: 99%

Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack

Edwards

Kapral

Fang

et al. 2017

CMAJ

View full text Add to dashboard Cite

Much of the risk of recurrent stroke accrues early after the index event,1-3 with population-based estimates ranging from 3.2% to 18.5% at 90 days after stroke 4 and 0.6% to 16.8% at 90 days after transient ischemic attack (TIA).5 The short-term risk of myocardial infarction is lower, ranging from 0.5% to 4.7% at 1 year, with a cumulative absolute risk of about 2% per year. 6 Because of these high rates of early recurrence, the 90-day period after stroke or TIA has been a major focus of secondary prevention in both research and clinical practice. [7][8][9] In addition to high short-term risks, population-based studies have shown that the risk of recurrent vascular events and death after stroke and TIA can remain elevated over the long term, with 5-and 10-year estimates approximating 18% and 44%, respectively.10-14 However, in most of these studies, risk estimates have included those with adverse outcomes in the early high-risk period, and few data have been available to characterize long-term risk in survivors who had no early complications after stroke or TIA. The purpose of this study was to determine the long-term risks of morbidity and mortality among survivors of ischemic stroke or TIA who did not experience any adverse complications in the first 90 days after discharge, relative to matched controls. ABSTRACT BACKGROUND: Secondary prevention after stroke and transient ischemic attack (TIA) has focused on high early risk of recurrence, but survivors of stroke can have substantial long-term morbidity and mortality. We quantified long-term morbidity and mortality for patients who had no early complications after stroke or TIA and community-based controls.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack

Edwards

Kapral

Fang

et al. 2017

CMAJ

View full text Add to dashboard Cite

show abstract

“…8 Using purposive sampling, patients, physicians and pharmacists who participated in the R x EACH trial 7 were eligible to participate in an individual semistructured telephone interview. A letter was sent to community pharmacists inviting them to participate and to identify patients and family physicians who were also involved in the study (to achieve a triad of patient, physician and pharmacist perspectives).…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…However, considering the universal nature of health care in Canada, there is no reason to believe these results are not relevant to other provinces, particularly those with similar expanded pharmacist roles. Although attempts were made to include family physicians who were involved in the care of patients in the R x EACH trial, 7 consent was obtained from only 1 physician who fulfilled this criterion. The remainder of the physicians were identified through a purposive, snowball sampling technique.…”

Section: Limitationsmentioning

confidence: 99%

“…Recent studies have reported effective pharmacist interventions on individual risk factors such as hypertension, diabetes and dyslipidemia. [4][5][6] The Alberta Vascular Risk Reduction Community Pharmacy Project: R x EACH trial 7 was recently conducted to evaluate the efficacy of a community pharmacy-based case-finding and intervention program in patients at high risk for CVD. Findings of the trial indicated that compared with usual care, the pharmacist-based intervention significantly reduced the risk of cardiovascular (CV) events.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Patient, family physician and community pharmacist perspectives on expanded pharmacy scope of practice: a qualitative study

et al. 2017

Self Cite

View full text Add to dashboard Cite

Background:The R x EACH trial was a randomized trial to evaluate the efficacy of community pharmacy-based case finding and intervention in patients at high risk for cardiovascular (CV) events. Community-dwelling patients with poorly controlled risk factors were identified and their CV risk reduced through patient education, prescribing and follow-up by their pharmacist. Perspectives of patients, family physicians and community pharmacists were obtained regarding pharmacists' identification and management of patients at high risk for CV events, to identify strategies to facilitate implementation of the pharmacist's expanded role in routine patient care. Methods:We used a qualitative methodology (individual semistructured interviews) with conventional qualitative content analysis to describe perceptions about community pharmacists' care of patients at high risk for CV events. Perceptions were categorized into macro (structure), meso (institution) and micro (practice) health system levels, based on a conceptual framework of care for optimizing scopes of practice. Results:We interviewed 48 participants (14 patients, 13 family physicians and 21 community pharmacists). Patients were supportive of the expanded scope of practice of pharmacists. All participant groups emphasized the importance of communication, ability to share patient information, trust and better understanding of the roles, responsibilities, accountabilities and liabilities of the pharmacist within their expanded role. Interpretation:Despite support from patients and changes to delivery of care in primary care settings, ongoing efforts are needed to understand how to best harmonize family physician and community pharmacist roles across the health system. This will require collaboration and input from professional associations, regulatory bodies, pharmacists, family physicians and patients. AbstractResearch Research CMAJ OPEN E206CMAJ OPEN, 5(1)

show abstract

“…In addition, a statistically and clinically significant reduction in SBP was obtained, as well as improvement in glycaemic control and improvement of the lipid profile. An important limitation of the study is the three-month follow-up period; this prevented assessment the impact of interventions on smoking cessation, and it makes one cautious about approaching with optimism the resulting reduction in cardiovascular risk [26]. These results are in part consistent with the observations made by Lee et al [27] wherein the pharmaceutical intervention among the geriatric patients significantly improved their lipid profiles (low-density lipoprotein [LDL] -0.86 ± 0.56 mmol/L, p = 0.038, triglyceride -1.15 ± 1.09 mmol/L, p < 0.001).…”

Section: Pharmaceutical Care Of Cardiology Patientsmentioning

confidence: 99%