Pharmacist care and the management of coronary heart disease: a systematic review of randomized controlled trials

Abstract

BackgroundSecondary prevention is important for reducing both mortality and morbidity of patients with coronary heart disease (CHD). Pharmacists can provide medication and also work on disease management for patients with CHD. This review has been carried out to evaluate the role of pharmacist care on mortality, morbidity, and the CHD management.MethodsThe PubMed, MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) to evaluate the impact of pharmacist care interventions on patients with CHD (in both community and hospital settings). Primary outcomes of interest were mortality, cardiovascular events and hospitalizations. Secondary outcomes were medication adherence, blood pressure control, and lipid management.ResultsFive RCTs (2568 patients) were identified. The outcomes were mortality, cardiovascular events, and hospitalizations in one study (421 patients), medication adherence in five studies, blood pressure in two studies (1914 patients), and lipid management in three studies (932 patients). The interventions of pharmacists included patient education, medication management, feedback to health care professionals, and disease management. There was no significant effect of pharmacist care on mortality, recurrent cardiac events or hospitalization of CHD patients. Significant positive effects of pharmacist care were shown on medication adherence in three studies, on blood pressure control in one study and on lipid management in one study.ConclusionIn this study, we concluded that pharmacists have a beneficial role in the care of CHD patients, although the evidence supporting positive impacts on mortality and morbidity remains uncertain due to the unavailability of data in these areas. Further research is needed to discern the contribution of pharmacist care on hard endpoints of CHD.

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

“…It merits mentioning that there are data that provider visits need not solely be with physicians. A recent review of pharmacist care in the management of CAD analyzed five studies in which pharmacist counseling not only resulted in greater adherence to secondary prevention therapies but, in some studies, lower cholesterol levels, lower blood pressure measurements, and lower rates of cardiovascular events [43]. Similarly, more intensive and frequent cardiac rehabilitation visits after MI has been associated with approximately 40% increase in medication adherence, as well as lower LDL-C and greater rates of smoking cessation [44].…”

Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community

“…Indeed, research has demonstrated the effectiveness of pharmacistprovided disease management activities, including for hypertension. [4][5][6][7][8][9][10] Specific to hypertension, a recent systematic 94 Circulation July 14, 2015…”

Pharmaceutical interventions in antiretroviral therapy: systematic review and meta-analysis of randomized clinical trials

“…Systematic reviews of the impact of pharmaceutical interventions on several diseases are available in the literature . As a function of the scarcity of studies in this field, most such reviews included fewer than 10 studies.…”