Effectiveness of Community Pharmacist Prescribing and Care on Cardiovascular Risk Reduction: Randomized Controlled RxEACH Trial

• Published in: Journal of the American College of Cardiology
• Main Authors: Tsuyuki, Ross T., BSc(Pharm), PharmD, MSc, FCSHP, FACC, Al Hamarneh, Yazid N., BSc(Pharm), PhD, Jones, Charlotte A., MD, PhD, FRCP(c), Hemmelgarn, Brenda R., MD, PhD, FRCP(c)
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Cardiovascular; Internal Medicine; eGFR; blood pressure; cardiovascular disease; estimated glomerular filtration rate; pharmacists; LDL-c; ASA; ACR; CVD; SD; glycated hemoglobin; smoking; UKPDS; acetylsalicylic acid, aspirin; cardiovascular risk; albumin to creatinine ratio; dyslipidemia; diabetes; HbA1c; United Kingdom Prospective Diabetes Study; low density lipoprotein cholesterol; standard deviation
• ISSN: 0735-1097
• DOI: 10.1016/j.jacc.2016.03.528

Abstract Background Despite the risk associated with hypertension, diabetes, dyslipidemia, and smoking, these cardiovascular disease (CVD) risk factors remain poorly identified and controlled. Objectives To evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk. Methods RxEACH was a randomized trial conducted in 56 community pharmacies across Alberta, Canada. Participants were recruited by their pharmacist, enrolling adults at high risk for CVD: those with diabetes, chronic kidney disease, previous vascular disease and/or Framingham Risk > 20% with ≥1 uncontrolled risk factor (blood pressure, LDL-cholesterol (LDL-c), HbA1c, or smoking). Patients were randomized to intervention or usual care groups. Intervention group received a Medication Therapy Management review from their pharmacist with 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. Usual care group received usual pharmacist care with no specific intervention. Primary outcome was difference in change in estimated CVD risk between intervention and usual care groups at 3 months. CVD risk was estimated using the greater of Framingham, International Score, or United Kingdom Prospective Diabetes Study risk engines. Results We enrolled 723 patients. Mean age was 62 (standard deviation, SD 12) years, 58% male and 27% smokers. After adjusting for baseline values and center effect, there was a 21% difference in CVD risk (p<0.001) between intervention and usual care groups. Intervention group had greater reductions of 0.2 mmol/L in LDL-c (p<0.001), 9.37 mmHg systolic blood pressure (p<0.001), 0.92% HbA1c (p<0.001), and 20.2% in smoking cessation (p=0.002). Conclusions RxEACH was the first large randomized trial of CVD risk reduction by community pharmacists, demonstrating a significant reduction in the risk for CVD events. Engagement of community pharmacists with an expanded scope of practice could have significant public health implications.