RxIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre-post intervention study

Yazid N Al Hamarneh, Carlo Marra, Robert Gniadecki, Stephanie Keeling, Andrea Morgan, Ross Tsuyuki, Yazid N Al Hamarneh, Carlo Marra, Robert Gniadecki, Stephanie Keeling, Andrea Morgan, Ross Tsuyuki

Abstract

Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.

Objective: To evaluate the effect of a pharmacist-led intervention on CV risk in patients with inflammatory conditions.

Methods: DESIGN: Prospective pre-postintervention.

Setting: 17 community pharmacies across Alberta.

Population: Adults with inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus, psoriasis vulgaris) who had at least one uncontrolled risk factor (A1C, blood pressure, LDL-cholesterol or current tobacco users).

Intervention: All patients enrolled in the study received: physical and laboratory assessment, individualised CV risk assessment and education regarding this risk, treatment recommendations, prescription adaptation and prescribing where necessary to meet treatment targets, regular communication with the patient's treating physician(s) and regular follow-up with all patients every month for 6 months.

Outcomes: Primary: change in estimated CV risk (risk of a major CV event in the next 10 years) after 6 months. Secondary: change in individual risk factors (blood pressure, LDL-cholesterol, A1C and tobacco cessation) over a 6-month period.

Results: We enrolled 99 patients. The median age was 66.41 years (IQR 57.64-72.79), More than half of them (61%) were female and more than three-quarters (86%) were Caucasians. After adjusting for age, sex and ethnicity and centre effect, there was a reduction of 24.5% in CV risk (p<0.001); including a reduction of 0.3 mmol/L in LDL-c (p<0.001), 10.7 mm Hg in systolic blood pressure (p<0.001), 1.25% in A1C (p<0.001). There was a non-significant trend towards tobacco cessation.

Conclusion: This is the first study on CV risk reduction in patients with inflammatory conditions in a community pharmacy setting. RxIALTA provides evidence for the benefit of pharmacist care on global cardiovascular risk reduction as well as the individual cardiovascular risk factors in patients with inflammatory conditions.

Trial registration number: NCT03152396.

Keywords: cardiac epidemiology; general diabetes; hypertension; lipid disorders; public health; rheumatology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Change in estimated CV risk over time. CV, cardiovascular.
Figure 3
Figure 3
Pharmacist interventions.

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