Value of the clinical pharmacist interventions in the application of the American College of Cardiology (ACC/AHA) 2018 guideline for cholesterol management

Abstract

Objectives The study aims to examine the extent to which the updated ACC/AHA management of blood cholesterol guideline (2018) is implemented in practice and to assess the value of the clinical pharmacist interventions in improving physicians’ adherence the guidelines recommendations. Methods We utilized in this study an interventional before-after design. The study was conducted on 272 adult patients who visited the study site internal medicine clinics and were candidates for statin therapy based on the 2018 ACC/AHA guidelines for cholesterol management. Adherence to guideline recommendations was measured before and after clinical pharmacists’ interventions by calculating the percentage of patients receiving statin therapy as per guideline recommendation, the type and intensity (moderate or high intensity) of statin therapy used, and the need for additional non-statin therapy. Results Adherence with guideline recommendations was significantly improved from 60.3% to 92.6% (X2 = 79.1, p = 0.0001) after clinical pharmacist interventions. Among patients who were on statin therapy, the percentage of those who were on proper statin intensity increased significantly from 47.6% to 94.4% (X2 = 72.5, p = 0.0001). The combination of statins with non-statin therapies such as ezetimibe and PCSK9 inhibitors increased from 8.5% to 30.6% (X2 = 95, p<0.0001) and from 0.0% to 1.6% (X2 = 6, p = 0.014), respectively. The use of other lipid-lowering agents was diminished from 14.6% to 3.2% (X2 = 19.2, p<0.0001). Conclusion Collaboration between physicians and clinical pharmacists is a crucial strategy to improve patients’ treatment and hence, achieve better health outcomes among patients suffering from dyslipidemia.

Adherence to the 2018 AHA cholesterol management guideline in hyperlipidemia treatment among adults in an outpatient setting

“…Correspondingly, Arca et al observed that out of the total statin-prescribed therapy, only 7.7% comprised high-intensity statin. Moreover, <20% of ASCVD patients (excluding those with recent ACS) were administered high-intensity statin ( 30 ). Other studies also show that high-intensity statin is prescribed to far fewer patients than recommended ( 13 , 30 ).…”

“…Moreover, <20% of ASCVD patients (excluding those with recent ACS) were administered high-intensity statin ( 30 ). Other studies also show that high-intensity statin is prescribed to far fewer patients than recommended ( 13 , 30 ). According to the results, most of the patients with severe hypercholesterolemia were undertreated by moderate-intensity statin, which opposes AHA Guideline recommendations.…”

“…Moreover, only 34.7% of patients with known ASCVD achieved LDL-C < 70 mg/dl, while 32.4% reached 70 < LDL-C < 100 mg/dl, and even 32.9% had LDL-C ≥ 100 mg/d, with moderate-intensity statin being the predominant intensity. It is crucial to optimize statin strategies in these patients to achieve the maximum reduction in cardiovascular outcomes ( 30 ). Approximately 17.9% of ASCVD patients failed to achieve LDL-C < 70 mg/dl, although they had taken high-intensity statin.…”

“…None of the patients with severe hypercholesterolemia reached their goals. The study by Arca et al examined heterozygous familial hypercholesterolemia, and likewise, most subjects did not reach the desired LDL-C goal ( 30 ).…”