Pharmacist-led care of stroke patients sees improved lipid levels
Pharmacist-led care of patients with a recent stroke leads to a significant improvement in cardiovascular (CV) risk factors, according to the results of a study published in the .
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Monthly visits with a prescribing pharmacist led to marked improvements in both systolic blood pressure (SBP) and levels of low-density lipoprotein (LDL) cholesterol among patients who had suffered a stroke, suggests the randomised controlled PREVENTION trial.
Patients in the “active control” arm of the study, who had their care overseen by nurses, also showed significant improvements in SBP and lipid levels over the study period. Interestingly, nurse-led care was most effective for achieving blood pressure control whereas pharmacist-led care was most effective for lowering lipids.
“We believe that both approaches hold great promise, not only for patients with stroke or transient ischemic attack but also for all patients with, or at high risk of, vascular disease, and our study provides much-needed information on their comparative effectiveness,” write the study authors, who were led by Finlay McAlister from the University of Alberta, Edmonton, Canada.
The study included 279 adults with a recent transient ischaemic attack or minor ischaemic stroke and poorly controlled SBP or lipid levels. At baseline, 98.2 per cent were taking an antiplatelet, 78.1 per cent were taking an antihypertensive medicine and 84.6 per cent were taking a statin.
Participants were randomly assigned to either nurse-led or pharmacist-led care, in addition to usual care. Nurses measured CV risk factors, counselled patients and faxed results to the primary care physician; pharmacists did these things as well as being authorised to initiate and titrate medicines to attain guideline-recommended targets (that is, SBP =140mmHg, fasting LDL cholesterol =2.0 mmol/L).
At the end of the six-month study, 43.4 per cent of patients under pharmacist care had achieved both SBP and lipid targets, compared with 30.9 per cent of patients in the nurse-led group. The absolute difference between groups was statistically significant, at 12.5 per cent, with a number needed to treat of 8 (P=0.03).
“The benefits of case management by pharmacists were largely driven by the higher proportion of patients who met their LDL cholesterol targets,” said Dr McAlister and colleagues (pharmacist-led group 51.1 per cent, nurse-led group 33.8 per cent; P=0.003), adding that results of subgroup analyses were consistent with the main results.
Meanwhile, nurse-led care appeared to be most effective for blood pressure control, with 89.7 per cent of patients reaching their target SBP by six months, compared with 80.4 per cent of patients under pharmacist care.
Citation: Electronicjuice DOI: 10.1211/PJ.2014.11137367
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