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    Pharmacists on the Front Line in Treating Cardiac Disease

    Pharmacists in all practice settings can make a difference.

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    Pharmacists have a role in the chronic disease state management of patients with cardiac disease.

    Since the push from Medicare and Medicaid, as well as from private payers, to manage complex disease states, health-care teams are managing these diseases, in large part through ambulatory clinics. The role of the pharmacist in this type of environment, says Norman P. Tomaka, BS Pharm, MS, a Media Liaison to APhA is to “ensure patients are compliant with their cardiac medications to help prevent readmissions and other untoward outcomes.”  But pharmacists in other settings have a role to play, too. In many hospitals, for example, pharmacists meet directly with patients to discuss medication regimens.    

    The value of the pharmacist as a member of the cardiac health-care team has been clearly documented. The 2017 Hypertension Clinical Practice Guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) recommend a team-based approach, which includes pharmacists,  in the treatment of hypertension. “There is high-quality evidence demonstrating that team-based models, particularly with pharmacists and nurses, improve hypertension treatment and control,  says Eric McLaughlin, PharmD, BCPS, FASHP, FCCP, who coauthored the guidelines as APhA’s representative. “With the formal recommendation to use a team-based approach for the care of hypertension patients, there would be an expanded role and opportunities [for pharmacists],”  says MacLaughlin in a written release.

    Table 1A study conducted in the cardiology unit of a university-affiliated hospital demonstrated that correction of drug-related problems (DRPs) by physicians after a pharmacist’s advice caused a significant decrease in mortality as analyzed by propensity-score (PS) matching. A total of 1,541 interventions were suggested by the clinical pharmacist in the study group; 1,416 (92%) of them were accepted by the cardiology team. All-cause mortality was reduced from 1.7% during Phase I (preintervention) to 1.0% during Phase II (postintervention). The difference was statistically significant (P=0.0074).1

    Clinics

    The pharmacist is valued as a member of the health-care team in treating patients with cardiac disease,” says Brittany Todd, PharmD, BCBS, CLS, Clinical Pharmacy Specialist in the Clinical Pharmacy Cardiac Risk Service (CPCRS), at Kaiser Permanente Colorado (KPCO) in an interview with Drug Topics. 

    At the facility, a team of clinical pharmacists and clinical pharmacy specialists manage most patients with atherosclerotic disease (ASCVD). “At KPCO, our providers know of the Clinical Pharmacy Cardiac Risk Service and rely on us for long-term management of their patients with ASCVD,”  says Todd. “As pharmacists, we work closely with our primary care providers, cardiologists, neurologists, and cardiac rehab nurses to ensure all parties are on the same page with patient care.” [see Table 1]

    “Within CPCRS, we are able to manage multiple disease states,” Todd continues. “Pharmacists ensure appropriate management of dyslipidemia, hypertension, diabetes, and smoking cessation. We order labs and instruct patients to follow up in clinics regarding blood pressure or any uncontrolled issue,” she says.

    “We work off a Collaborative Drug Therapy Management document that outlines what we can and cannot do,” Todd says. The physician representatives for KPCO review this document annually to ensure that pharmacists manage their patients appropriately based on guidelines, evidence-based medicine, and safe practices. Because of the protocol, “we make therapy changes. We simply notify the physician of any therapy changes we made,” she says.

    “I feel our providers understand what a pharmacist brings to the table—medication expertise—and truly appreciate our role,” Todd says.

    Hospital Pharmacy

    A collaboration between a pharmacy and a hospital in Virginia is serving the needs of cardiac patients as they transition from hospital to discharge. Bremo Pharmacy, which also has a long-term care and community pharmacy in its group, is situated right in Henrico Doctors’ Hospital in Richmond, VA.

    Up next: What this means for hospital and community pharmacy

    Kathleen Gannon Longo
    Kathleen Gannon Longo is a Contributing Editor.

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