The Effectiveness of Pharmacist Interventions on Cardiovascular Risk: The Multicenter Randomized Controlled RxEACH Trial. A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway – a randomized controlled trial Cardiovascular disease risk reduction in rural China: a clustered randomized controlled trial in Zhejiang Physicians' perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. The role of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: A prospective, nonrandomized controlled trial using propensity score methods. An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial Effectiveness of a tailored intervention to improve cardiovascular risk management in primary care: study protocol for a randomised controlled trial Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): A Randomized Trial Design of the Effect of a Community Pharmacist Intervention Program on Serum Cholesterol Risk Pharmacist intervention in the prevention of heart failure for high-risk elderly patients in the community [Evaluation of the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in primary care: the PREseAP Study]. Cardiovascular risk factors in type 2 diabetic patients: multifactorial intervention in primary care. Effectiveness of Pharmacist Interventions on Cardiovascular Risk in Patients With CKD: A Subgroup Analysis of the Randomized Controlled RxEACH Trial. Secondary prevention of cardiovascular disease: a randomised trial of training in information management, evidence-based medicine, both or neither: the PIER trial. IMProving Adherence using Combination Therapy (IMPACT): design and protocol of a randomised controlled trial in primary care. A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. Efforts to improve subsequent treatment of cardiovascular risk factors in older patients with diabetes hospitalized for a cardiac event.
BACKGROUND Despite the cardiovascular disease ( CVD ) risk associated with hypertension , diabetes , dyslipidemia , and smoking , these risk factors remain poorly identified and controlled . OBJECTIVES The study sought to evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk . METHODS The RxEACH ( Alberta Vascular Risk Reduction Community Pharmacy Project ) study was a r and omized trial conducted in 56 community pharmacies . Participants were recruited by their pharmacist , who enrolled adults at high risk for CVD . Patients were r and omized to usual care ( usual pharmacist care with no specific intervention ) or intervention , comprising a Medication Therapy Management review from their pharmacist and CVD risk assessment and education . Pharmacists prescribed medications and ordered laboratory tests as per their scope of practice to achieve treatment targets . Subjects received monthly follow-up visits for 3 months . The primary outcome was difference in change in estimated CVD risk between groups at 3 months . CVD risk was estimated using the greater of the Framingham , International , or United Kingdom Prospect i ve Diabetes Study risk scores . RESULTS We enrolled 723 patients ( mean 62 years of age ; 58 % male , and 27 % smokers ) . After adjusting for baseline values and center effect , there was a 21 % difference in change in risk for CVD events ( p < 0.001 ) between the intervention and usual care groups . The intervention group had greater improvements in low-density lipoprotein cholesterol ( -0.2 mmol/l ; p < 0.001 ) , systolic blood pressure ( -9.37 mm Hg ; p < 0.001 ) , glycosylated hemoglobin ( -0.92 % ; p < 0.001 ) , and smoking cessation ( 20.2 % ; p = 0.002 ) . CONCLUSIONS The RxEACH study was the first large r and omized trial of CVD risk reduction by community pharmacists , demonstrating a significant reduction in risk for CVD events . Engagement of community pharmacists with an exp and ed scope of practice could have significant public health implication s. ( The Alberta Vascular Risk Reduction Community Pharmacy Project : RxEACH [ RxEACH ] ; NCT01979471 ) Objectives : The aim of the study was twofold ; 1 ) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease ( CHD ) discharged from the University Hospital of North Norway , and 2 ) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors . Methods : A total of 102 patients aged 18 - 82 years were enrolled in a non-blinded r and omized controlled trial with an intervention group and a control group . The intervention comprised medication reconciliation , medication review and patient education during three meetings ; at discharge , after three months and after twelve months . The control group received st and ard care from their general practitioner . Primary outcomes were adherence to clinical guideline recommendations concerning prescription , therapy goal achievement and lifestyle education  defined in the medication assessment tool for secondary prevention of CHD ( MAT-CHDSP ) . Secondary outcomes included changes in the biomedical risk factors cholesterol , blood pressure and blood glucose . Results : Ninety-four patients completed the trial , 48 intervention group patients and 46 controls . Appropriate prescribing was high , but therapy goal achievement was low in both groups . Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end , 78.4 % vs. 62.0 % , p<0.001 . The difference was statistically significant for the documented lifestyle advices in intervention group patients . No significant improvements in biomedical risk factors were observed in favor of the intervention group . Conclusions : The study showed an increased guideline adherence in both study groups . This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task . A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention . Amendments to the follow-up program are suggested before implementation in st and ard patient care can be recommended Background Cardiovascular disease ( CVD ) is a major cause of death in China . Despite government efforts , the majority of hypertensive and diabetic patients in China do not receive proper treatment . Reducing CVD events requires long-term care that is proactive , patient-centred , community-based , and sustainable . We have design ed a package of interventions for patients at high risk of CVD to be implemented by family doctors based in township hospitals ( providers of primary care ) in rural Zhejiang , China . This trial aims to determine whether the systematic CVD risk reduction package results in reduced CVD events among patients at risk of CVD compared with usual care , and whether the package is cost-effective and suitable for routine implementation and scale-up . Methods / Design This is a prospect i ve , open-label , cluster r and omized controlled trial ( RCT ) with blinded data analysis . The trial will r and omize 67 township hospitals with 31,708 participants in three counties in Zhejiang Province . Participants will be identified from existing health records and will comprise adults aged 50 to 74 years , with a calculated 10-year CVD risk of 20 % or higher , or diabetes . In the intervention arm , participants will receive a package of interventions including : 1 ) healthy lifestyle counseling ( smoking cessation , and salt , oil , and alcohol reduction ) ; 2 ) prescription of a combination of drugs ( antihypertensives , aspirin , and statin ) ; and 3 ) adherence support for drug compliance and healthy lifestyle change . In the control arm , participants will receive usual care for hypertension and diabetes management at individual clinicians ’ discretion . The primary outcome is the incidence of severe CVD events over 24 months of follow-up . All CVD events will be defined according to the World Health Organization ( WHO ) monitoring of trends and determinants in cardiovascular disease ( MONICA ) definitions , diagnosed at the county hospital or higher level , and reported by the Zhejiang surveillance system . Secondary outcomes include : mean systolic and diastolic blood pressure , blood glucose , serum total cholesterol ( TC ) , and adherence to appointments , and drugs and lifestyle changes . Discussion This trial focuses on risk reduction of CVD rather than specific diseases . It is not design ed to compare therapeutic and healthy lifestyle interventions , but rather their combined effects in primary care setting s. Through the trial , we intend to underst and the effectiveness of the comprehensive CVD reduction package in routine practice . We also intend to underst and the barriers and facilitators to implementing the package , and thus to advise on policy and practice change . Trial registration Current Controlled Trials : IS RCT BACKGROUND Cardiovascular diseases ( CVD ) are the major cause of premature death in the world . This study was design ed to examine the physicians ' knowledge and perception of CVD risk factors and perceived implementation of CVD prevention guidelines as well as barriers to their implementation . METHODS A question naire survey by face-to-face interviews was performed among 1382 r and omly selected physicians ( general practitioners/family medicine specialists , internists and cardiologists ) from different regions of Croatia . RESULTS Most physicians believe that guidelines are useful but only 56.9 % are really using some guidelines . 40.2 % favour Joint European guidelines . More primary care physicians use their own personal experience in prevention while internists and cardiologists tend more to use the guidelines . 80.6 % believe that they treat their patients with dyslipidemia well but only 53.3 % knew the LDL-cholesterol goal value for high-risk patients and only 56.2 % knew which HDL-cholesterol level is the marker of increased risk . Hypertension was perceived as the most important risk factor , particularly by primary care physicians , while cardiologists tend to favour diabetes . Although most physicians considered the lack of financial re sources as the main barrier in CVD prevention , at the same time most of them believe that it could primarily be improved by better patient education . CONCLUSIONS Although most physicians support the guidelines use , only half of them use them and in average their knowledge of guidelines is not satisfactory . This is , together with the lack of time and finances and perceived lack of patients ' awareness , probably one of the main causes why they do not manage risk factors better BACKGROUND Meta-analyses have suggested that pharmacist-led medication review s have no discernable effect on  patient mortality .  These analyses may not have found a statistically significant effect because they did not adequately control for the patient selection parameters . Therefore , a more precise approach to evaluating the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients is required . OBJECTIVE To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to cardiology units . METHODS A prospect i ve , nonr and omized observational study compared patients who received st and ard care with patients admitted to a service that included clinical pharmacists . Propensity score matching was applied to enhance the comparability . The primary endpoint of the study was the composite of all-cause mortality in the study group and the control group . RESULTS Pharmacists were consulted by physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward . A total of 428 interventions were suggested by the clinical pharmacist in the study group ; 375 ( 87.6 % ) of them were accepted by the cardiology team . All-cause mortality was 1.8 % during phase 1 treatment ( preintervention ) and was reduced to 1.1 % during phase 2 treatment ( postintervention ) ; the difference was statistically significant . There was no statistical difference in all-cause mortality in the control unit between phase 1 and phase 2 . Results were similar in the propensity score-matched subcohort . CONCLUSIONS Drug-related problems that were suspected to cause or contribute to a possibly fatal outcome were determined by the clinical pharmacist service in patients hospitalized in a cardiology ward . Correction of these drug-related problems by physicians after the pharmacist 's advice caused a significant decrease in mortality as analyzed by propensity score matching . The significant reduction in the mortality rate in this patient population observed in this study is " hypothesis generating " for future r and omized studies Background Cardiovascular diseases ( CVD ) are responsible for significant morbidity , premature mortality , and economic burden . Despite established evidence that supports the use of preventive medications among patients at high CVD risk , treatment gaps remain . Building on prior evidence and a theoretical framework , a complex intervention has been design ed to address these gaps among high-risk , under-treated patients in the Australian primary care setting . This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities ; availability of a range of CVD polypills ( fixed-dose combinations of two blood pressure lowering agents , a statin ± aspirin ) for prescription when appropriate ; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification . Methods Following a systematic development process , the intervention will be evaluated in a pragmatic cluster r and omized controlled trial including 70 general practice s for a median period of 18 months . The 35 general practice s in the intervention group  will work with a nominated partner pharmacy , whereas those in the control group will provide usual care without access to the intervention tools . The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) levels at the study end . The outcomes will be analyzed using data from electronic medical records , utilizing a vali date d extraction tool . Detailed process and economic evaluations will also be performed . Discussion The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients , pharmacists , and general practitioners ( GPs ) for CVD prevention . Trial registration Australian New Zeal and Clinical Trials Registry Abstract Background Cardiovascular disease ( CVD ) is an important worldwide cause of mortality . In The Netherl and s , CVD is the leading cause of death for women and the second cause of death for men . Recommendations for diagnosis and treatment of CVD are not well implemented in primary care . In this study , we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with ( high risk for ) CVD . Methods / design A two-arm cluster r and omized trial is planned . We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values , risk profiling and lifestyle advice . Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management ( CVRM ) . They are also advised to screen for the presence and severity of depressive symptoms in patients . We also advise practice nurses to use selected E-health options ( selected websites and Twitter-consult ) in patients without symptoms of depression . Patients with mild depressive symptoms are referred to a physical exercise group . We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM .  Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practice s in several geographical areas in The Netherl and s. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients . Patients ’ health-related lifestyles ( physical exercise , diet and smoking status ) will be measured with vali date d question naires and medical record audit will be performed to document estimated CVD risk . Additionally , we will survey and interview participating healthcare professionals for exploration of processes of change . The control practice s will provide usual care . Discussion Tailored interventions can improve healthcare . An underst and ing of the methods to reach the improved healthcare can be improved . This research contributes a share of it . Identification of the determinants of practice and developing implementation interventions were two steps which were completed . The subsequent step was implementation of the tailored intervention program . Trial registration Name trial register : Nederl and s trial registerWeb address of trial register : http://www.trialregister.nl Data of registration : 11 July 2013Number of registration : BACKGROUND Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease ( CVD ) , more evidence derived from r and omized controlled trials ( RCTs ) is needed , including assessment of the effect of community pharmacist interventions in patients with CVD . OBJECTIVE To assess the effectiveness of the Dader Method for pharmaceutical care on achieving therapeutic goals for blood pressure ( BP ) , total cholesterol ( TC ) , and both BP and TC ( BP/TC ) in patients with CVD and /or high or intermediate cardiovascular ( CV ) risk attending community pharmacies in Spain . METHODS Patients aged 25 to 74 years attending community pharmacies with a prescription for at least 1 drug indicated for CVD or CV risk factors were r and omized to 2 groups : an intervention group that received pharmaceutical care , which was provided by specially trained pharmacists working in collaboration with physicians , and a control group that received usual care ( routine dispensing counseling ) and verbal and written counseling regarding CVD prevention .  Patients were recruited from December 2005 to September 2006 , and both groups were followed for 8 months . Study outcomes were assessed at baseline and at 16 and 32 weeks after r and omization . The primary outcome measures were the proportions of patients achieving BP , TC , and BP/TC therapeutic goals ( BP lower than 140/90 mm Hg for patients with uncomplicated hypertension and lower than 130/80 mm Hg for patients with diabetes , chronic kidney disease , or history of myocardial infa rct ion or stroke ; TC lower than 200 mg per dL for patients without CVD and lower than 175 mg per dL for patients with CVD ) . Secondary outcomes were mean BP and TC values . BP was assessed manually by the pharmacist after a 10-minute rest in the supine position . This measurement was performed twice for every participant , and the average of the 2 measurements was calculated . TC was measured by the pharmacist during the study visit using the enzymatic dry method . Statistical analyses were performed using 2-tailed McNemar tests , Pearson chi-square tests , and Student 's t-tests ; P < 0.05 was considered statistically significant . RESULTS 714 patients were included in the study ( 356 intervention , 358 control ) , and the mean [ SD ] age was 62.8 [ 8.1 ] years . The 2 groups were similar at baseline in clinical and demographic characteristics , including the proportion of patients at therapeutic goals for BP , TC , and BP/TC . After 8 months of follow-up , there were statistically significant differences in favor of pharmaceutical care in the proportions of patients who achieved therapeutic goals for BP ( 52.5 % vs. 43.0 % , P=0.017 ) , TC ( 56.5 % vs. 44.1 % , P=0.001 ) , and BP/TC ( 37.1 % vs. 21.8 % , P < 0.001 ) . CONCLUSION Compared with usual care plus written education , pharmaceutical care focused on patient evaluation and follow-up in collaboration with physicians improved the achievement of BP , TC , and BP/TC treatment goals in patients with CVD and /or high or intermediate CV risk attending community pharmacies in Spain OBJECTIVE : To determine the efficacy of a program of intervention by pharmacists on lipid risk management in patients at high risk for cardiovascular events . METHODS : R and omized , multicenter ( 44 sites in Alberta and Saskatchewan ) study of community pharmacist intervention versus usual care in 1000 patients . Patients are those at high risk of vascular events ( existing atherosclerotic vascular disease , or diabetes with ≥1 other risk factor ) . After obtaining consent , the pharmacist calls the Project Office to r and omize . Patients allocated to intervention receive a brochure and education about cardiovascular risk factors . Pharmacists also complete a physician contact form , which lists the patient 's risk factors , medications , and any recommendations . A point-of-care cholesterol test is performed , the result is discussed with the patient , and it is entered on the contact form . If appropriate , the patient is asked to see his or her primary care physician for further assessment and /or treatment , and the form is faxed to the physician . Patients are followed up at two , four , eight , 12 , and 16 weeks . During follow-up visits , pharmacists provide educational reinforcement and check for primary end point occurrence . Patients allocated to usual care receive the brochure only , with minimal follow-up . The primary end point is a composite of measurement of a complete lipid panel by the physician , or addition or modification of lipid-lowering drug therapy . Sub studies will evaluate economics ( third-party payer and pharmacy manager perspective ) , patient satisfaction , and quality of life . CONCLUSIONS : SCRIP ( Study of Cardiovascular Risk Intervention by Pharmacists ) is a unique ongoing trial that is evaluating a community pharmacist intervention design ed to optimize cholesterol risk management in patients at high risk for cardiovascular events Background Heart failure has become one of the major causes of hospitalization worldwide . Hypertension , diabetes mellitus and hyperlipidemia are the major causes of heart failure . In order to effectively prevent heart failure , blood pressure , blood glucose and cholesterol levels shall be closely monitored and controlled as well as medication adherence . This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in high risk elderly patients in the community of Hong Kong . Aim This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in highrisk elderly patients in the community of Hong Kong . Methods This prospect i ve uncontrolled study was conducted between July 2012 and April 2013 with two revisits every 3 to 4 months to review elderly patients ’ medication profiles as well as assess their blood pressure ( BP ) , r and om capillary blood glucose ( RCBG ) level , cholesterol levels , signs and symptoms of heart failure and the compliance level . The results collected at the baseline data were analyzed and compared with those collected at the last follow-up visit . Result A significant increase in number of subjects free of symptoms of heart failure ( 31.88 % , p < 0.001 ) was found . For chronic disease management , significant reduction in LDL-cholesterol level ( -0.86 ± 0.56mmol/L , p = 0.038 ) and triglyceride level ( -1.15 ± 1.09mmol/L , p < 0.001 ) was observed in overall participants . Yet , no significant reduction in BP level or RCBG level was observed in overall subjects . Significant reduction in mean Morisky Medication Adherence Score ( -0.54 ± 1.50 , p = 0.005 ) indicated improvement in medication compliance in participants . Conclusion The Pharmacy Outreach service has a significant role in prevention of heart failure , by means of minimizing heart failure symptoms , improving medication compliance and enhancing chronic disease management , particularly cholesterol management in community elderly patients . This study provided a reference for further investigation and evaluation of the role of pharmacists in preventing heart failure in the high-risk community elderly patients OBJECTIVES To assess the efficacy of a comprehensive secondary prevention programme to reduce morbidity and mortality in patients who have suffered a cardiovascular ( CV ) event ; to control CV risk factors and prophylactic treatment in order to prevent recurrence ; and to improve the quality of life of patients with cardiovascular disease . DESIGN R and omised , pragmatic , open clinical trial in primary care . SETTING A total of 42 primary care centres of 8 different areas in Spain . PARTICIPANTS Men and women below 86 years old , diagnosed with coronary disease and /or stroke and /or peripheral vascular disease in the preceding year , and who have no serious or terminal disease . INTERVENTION Primary care centres will be r and omised to following usual care ( control group ) , or to following a comprehensive programme of secondary prevention ( intervention group ) . MAIN MEASUREMENTS Cardiovascular fatal events , cardiovascular non-fatal events , total mortality and health-related quality of life ( SF-36 ) BACKGROUND Cardiovascular disease is the main cause of morbidity and mortality in patients with type 2 diabetes mellitus ( DM ) . Intervention on  cardiovascular risk factors  ( CVRF ) is essential to obtain clinical results reducing the excess of cardiovascular risk ( CVR ) in these patients . METHODS The objective of this study was to describe the association of type 2 DM with modifiable cardiovascular risk factors and the degree of control of these in a population of type 2 diabetics in attendance in primary care clinics , and also to establish prospect ively whether an integral and multifactorial intervention on uncontrolled cardiovascular risk factors , carried out in conditions of routine clinical practice by applying an open protocol , could significantly reduce the estimated CVR according to the Framingham scale . The proposed intervention included both actions aim ed at modifying habits , and pharmacologic intervention to achieve an optimum level of control in accordance with international recommendations for the objectives and treatment for type 2 diabetes . RESULTS A total of 3466 patients with a mean age of 58 + /- 7.5 years were studied and followed-up for 1 year . Of these , 90.4 % of patients had high blood pressure ; 60.1 % of men and 32.7 % of women presented CVR > 20 % in 10 years according to the Framingham scale by categories . Intervention at 1 year of follow-up had achieved statistically significant reductions in blood pressure , glycated hemoglobin , and lipid levels , but not of patients ' body weight . After 1 year of follow-up , 29 % of males and 24 % of women with a high CVR ( > 20 % ) at the start of the study presented reduced risk levels . CONCLUSION The results of the study demonstrate that an integrated and multifactorial intervention in type 2 diabetic patients can achieve clinical ly significant reductions in CVR . However , conducted in effective conditions , it is not able to achieve optimum levels of control in spite of the initial proposal , possibly due to some degree of inertia in routine clinical practice BACKGROUND Affecting a substantial proportion of adults , chronic kidney disease ( CKD ) is considered a major risk factor for cardiovascular ( CV ) events . It has been reported that patients with CKD are underserved when it comes to CV risk reduction efforts . STUDY DESIGN Prespecified subgroup analysis of a r and omized controlled trial . SETTING & PARTICIPANTS Adults with CKD and at least 1 uncontrolled CV risk factor were enrolled from 56 pharmacies across Alberta , Canada . INTERVENTION Patient , laboratory , and individualized CV risk assessment s ; treatment recommendations ; prescription adaptation(s ) and /or initiation as necessary ; and regular monthly follow-up for 3 months . OUTCOMES The primary outcome was change in estimated CV risk from baseline to 3 months after r and omization . Secondary outcomes were change between baseline and 3 months after r and omization in individual CV risk factors ( ie , low-density lipoprotein cholesterol , blood pressure , and hemoglobin A1c ) , risk for developing end-stage renal disease , and medication use and dosage ; tobacco cessation 3 months after r and omization for those who used tobacco at baseline ; and the impact of rural versus urban residence on the difference in change in estimated CV risk . MEASUREMENTS CV risk was estimated using the Framingham , UK Prospect i ve Diabetes Study , and international risk assessment equations depending on the patients ' comorbid conditions . RESULTS 290 of the 723 participants enrolled in RxEACH had CKD . After adjusting for baseline values , the difference in change in CV risk was 20 % ( P<0.001 ) . Changes of 0.2mmol/L in low-density lipoprotein cholesterol concentration ( P=0.004 ) , 10.5mmHg in systolic blood pressure ( P<0.001 ) , 0.7 % in hemoglobin A1c concentration ( P<0.001 ) , and 19.6 % in smoking cessation ( P=0.04 ) were observed when comparing the intervention and control groups . There was a larger reduction in CV risk in patients living in rural locations versus those living in urban areas . LIMITATIONS The 3-month follow-up period can be considered relatively short . It is possible that larger reduction in CV risk could have been observed with a longer follow up period . CONCLUSIONS This subgroup analysis demonstrated that a community pharmacy-based intervention program reduced CV risk and improved control of individual CV risk factors . This represents a promising approach to identifying and managing patients with CKD that could have important public health implication BACKGROUND Sub-optimal management of cardiovascular disease ( CVD ) patients is widespread in primary and secondary care , with risk factors frequently unrecorded or untreated . AIM To investigate the effectiveness of educational interventions developed in primary care , on recording , prescribing and control of risk factors among all patients recorded by their general practitioner as having CVD . DESIGN OF STUDY Factorial , duster-r and omised controlled trial . SETTING Primary care teams representing the range of practice development in a geographically defined area in inner London . METHOD Participating practice s were r and omly allocated to one of the four intervention groups : information , evidence , both or neither . Interventions were tailored to suit individual practice needs . At a mean of 19 months after baseline , and three months after the end of intervention , practice s carried out the follow-up assessment of recording , treatment , and control of risk factors in the same CVD patients . RESULTS Adequate recording of all three risk factors , found inapproximately a third of patients at baseline , increased non-significantly by 10.5 % ( 95 % confidence interval [ CI ] = 3.9 to 24.9 ) in the information ( versus not information ) group and by 6.6 % ( 95 % [ CI ] = 8.9 to 22.0 ) in the evidence ( versus not evidence ) group . Factorial improvements in prescribing and control of risk factors tended not to be significant . Adequate recording of an three risk factors showed the greatest improvement in the information plus evidence group ( 19.9 % increase , P for heterogeneity across the four groups < or = 0.001 ) . Mean change from baseline to follow-up within the four intervention groups suggested improvements in the combined information plus evidence group in cholesterol recording ( 22.5 % increase ) , prescribing of lipid lowering drugs ( 4.4 % increase ) and mean cholesterol ( 0.7 mmol/l decrease ) . CONCLUSIONS Adequate risk factor recording did not differ between the information ( versus not information ) or the evidence ( versus not evidence ) intervention groups . Combined training in information systems and evidence -based medicine should be considered in the design of future interventions , to improve secondary prevention of CVD BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death , and principal reason for the large difference in life expectancy between indigenous Māori and the non-indigenous population in New Zeal and . CVD guidelines recommend that people who are at high risk or who have had previous CVD should be offered aspirin , blood pressure lowering and lipid lowering therapies . However , prescribing and adherence rates are low and CVD events remain high . AIM To assess whether a medication strategy using a fixed dose combination pill ( ' polypill ' ) could improve prescribing and adherence to recommended medications , lower blood pressure and improve lipids compared with current care over 12 months . METHODS IMProving Adherence using Combination Therapy ( IMPACT ) is an open-label r and omised controlled trial comparing a once-daily polypill containing four preventive medications with usual care .  Six hundred participants who have had previous CVD events or are at high risk of CVD will be enrolled , including 300 Māori . Participants are identified , enrolled and prescribed either the polypill or current medications at their usual primary health care practice , with medications ( including the polypill ) dispensed through local community pharmacies . The polypill contains 75 mg aspirin , 40 mg simvastatin , 10 mg lisinopril and either 12.5 mg hydrochlorothiazide or 50 mg atenolol . Primary outcomes are adherence to guidelines -recommended medications and changes in systolic blood pressure and low density lipoprotein at 12 months . Secondary outcomes include other lipids , medication dispensing , barriers to adherence , CVD and other serious adverse events , quality of life and prescriber acceptability . The trial is registered with the Australian New Zeal and Clinical Trial Registry ( ACTRN12606000067572 ) BACKGROUND It has been demonstrated in previous studies that pharmacist management of patients with type 2 diabetes mellitus ( T2DM ) in the outpatient setting not only improves diabetes-related clinical outcomes such as hemoglobin A1c but also blood pressure ( BP ) , total cholesterol ( TC ) , and quality of life . Improved control of BP and TC has been shown to reduce the risks of cardiovascular disease ( CVD ) , which has placed a heavy economic burden on the health care system . However , no study has evaluated the cost-effectiveness of pharmacist intervention programs with respect to the long-term preventive effects on CVD outcomes among T2DM patients . OBJECTIVES To ( a ) quantify the long-term preventive effects of pharmacist intervention on CVD outcomes among T2DM patients using evidence from a matched cohort study in the outpatient primary care setting and ( b ) assess the relative cost-effectiveness of adding a clinical pharmacist to the primary care team for the management of patients with T2DM based on improvement in CVD risks with the aid of an economic model . METHODS Clinical data between the periods of June 2007 to February 2010 were collected from electronic medical records at 2 separate clinics at Kaiser Permanente ( KP ) Northern California , 1 with primary care physicians only ( control group ) and the other with the addition of a pharmacist ( enhanced care group ) . Patients in the enhanced care group were matched 1:1 with patients in the control group according to baseline characteristics that included age , gender , A1c , and Charlson comorbidity score . The estimated 10-year CVD risk for both groups was calculated by the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Risk Engine ( version 2 ) based on age , sex , race , smoking status , atrial fibrillation , duration of diabetes , levels of A1c , systolic BP ( SBP ) and TC , and high-density lipoprotein cholesterol ( HDL-C ) observed at 12 months . There was no statistical difference in the baseline clinical inputs to the Risk Engine ( A1c [ P=0.115 ] , SBP [ P=0.184 ] , TC [ P=0.055 ] , and HDL-C [ P=0.475 ] ) between the 2 groups . A Markov model was developed to simulate the estimated CVD outcomes over 10 years and to estimate cost-effectiveness . The final outcomes examined included incremental cost and effectiveness measured by life years and per quality -adjusted life year gained . Both deterministic sensitivity analysis ( SA ) and probabilistic SA were conducted to examine the robustness of the results . RESULTS The estimated risks for coronary heart disease ( CHD ) and stroke ( both nonfatal and fatal ) at the end of the follow-up were consistently lower in the enhanced care group compared with the control group , even though baseline risks in both groups were similar . The absolute risk reduction ( ARR ) between the enhanced care and control groups increased over time . For example , the ARR for nonfatal CHD risk in year 1 was 0.5 % ( 1.2 % vs. 0.7 % ) , whereas the ARR increased to 5.5 % in year 10 ( 14.8 % vs. 9.3 % ) . Similarly , the ARR between the enhanced care and the control groups was calculated as 0.3 % for fatal CHD in year 1 and increased to 4.6 % in year 10 . Results from the Markov model suggest that the enhanced care group was shown to be a dominant strategy ( less expensive and more effective ) compared with the control group in the 10-year evaluation period in the base-case ( average or mean results ) scenario . Sensitivity analysis that took into account the uncertainty in all important variables , such as wage of pharmacists , utility weight ( the degree of preference individuals have for a particular health state or condition ) , response rate to pharmacists ' care , and uncertainty associated with the estimated 10 years of CVD risk , revealed that the relative value of enhanced care was robust to most of the variations in these parameters . Notably , the level of cost-effectiveness measured by net monetary value depends on the time horizon adopted by the payers and the magnitude of CVD risk reduction . The enhanced care group has a higher chance of being considered as a cost-effective strategy when a longer time horizon such as a minimum of 4 to 5 years is adopted . CONCLUSIONS Adding pharmacists to the health care management team for diabetic patients improves the long-term CVD risks . The longer-term CVD risk reductions were shown to be more dramatic than the short-term reduction . A longer time horizon adopted by health plans in managing T2DM patients has a higher probability of making the intervention cost-effective OBJECTIVE To improve the treatment of risk factors of cardiovascular disease ( CVD ) for older patients with diabetes after a cardiac event by using a low-literacy reminder card describing these risk factors in community setting s. STUDY DESIGN A multicenter , r and omized , interventional study . METHODS Patients aged 55 years or older with diabetes hospitalized with an acute myocardial infa rct ion , congestive heart failure exacerbation , or unstable angina were eligible to enter the study . Control and experimental patients were recruited from 4 sites and were enrolled in the study before discharge from the hospital . Experimental subjects received education and a reminder card describing risk factors of CVD . They were instructed to discuss the risk factors described on the reminder card with their primary care physician on their first appointment after discharge . Control subjects did not receive any intervention but were given consent to be able to review their charts . RESULTS One hundred sixty patients completed the study , 82 in the control group and 78 in the experimental group . At the end of the study there was no difference in blood pressure control , lipid levels , and glycosylated hemoglobin levels between the control and experimental patients . Aspirin use and ACE inhibitor use were found to be significantly higher in the control group ( P = .001 and .03 , respectively ) . CONCLUSIONS Reminder cards given to patients to discuss with their primary care providers in community setting s did not improve process measures of CVD risk in patients with documented CVD and diabetes . Other approaches will be needed to improve the treatment of risk factors in these high-risk patients
68 % of the outcomes reported showed that clinical pharmacy services were associated with better improvement in patients ' outcomes compared with the control group .
The involvement of a pharmacist demonstrated an ability to improve CVD outcomes through providing educational intervention , medicine management intervention , or a combination of both .
These interventions result ed in improved CVD risk factors , improved patient outcomes , and reduced number of drug-related problems with a direct effect on CVD control .
These improvements may lead to an improvement in patient quality of life , better use of health care re sources , and a reduced rate of mortality
BACKGROUND Cardiovascular disease ( CVD ) is considered to be the main cause of death and one of the most common diseases affecting health care systems worldwide .
Many methods have been used to improve CVD outcomes , one of which is to involve clinical pharmacists in the direct care of patients with CVD .
OBJECTIVE To perform a systematic review assessing the effectiveness of clinical pharmacist interventions within a multidisciplinary team in the secondary prevention of CVD , using studies conducted on patients with heart failure , coronary heart disease , or those with CVD risk factors .