Abstract
Purpose of Review
The burden of cardiovascular disease (CVD) in the USA remains unacceptably high. The associated morbidity and mortality of CVD has important implications on our healthcare system and society. With much of CVD considered preventable an increase emphasis on primary prevention is important. To review the evidence for pharmacists providing CVD primary prevention, particularly as a part of employer-based programs.
Recent Findings
A recent study evaluated the impact of a pharmacist-led 12-month preventative health program in 178 at-risk employees at University of British Columbia (UBC). Cardiovascular Assessment and Medication Management by Pharmacists at UBC (CAMMPUS) resulted in improved Framingham risk scores (FRS) from 11.7 to 10.7 (p = 0.0017), improvement in quality of life (p = 0.023), and medication adherence (p = 0.019). Findings are consistent with improvements observed in other pharmacist-led intervention trials but offer the unique perspective as an employer-based intervention.
Summary
Pharmacists-led interventions prevent CVD through improvement in health markers and medication adherence. The ability of pharmacists to provide these as part of an employer-sponsored benefit might be favorable as other billing models for pharmacist can be challenging to be justified in a fee-for-service payment structure; further, there is incentive for employers to lower healthcare cost and improve productivity. Future studies defining the impact of pharmacists in this and other settings may have important public health implications.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528. https://doi.org/10.1161/CIR.0000000000000659.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52. https://doi.org/10.1016/S0140-6736(04)17018-9.
•• Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596–646. https://doi.org/10.1161/CIR.0000000000000678 Recent guidelines provide updates on all pharmacologic and non-pharmacologic therapies for prevention of disease.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168–209. https://doi.org/10.1016/j.jacc.2018.11.002.
Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59. https://doi.org/10.1016/j.jacc.2013.11.005.
Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017;6:2048004016687211. https://doi.org/10.1177/2048004016687211.
Uijl A, Koudstaal S, Vaartjes I, Boer JMA, Verschuren WMM, van der Schouw YT, et al. Risk for heart failure: the opportunity for prevention with the American Heart Association's Life’s simple 7. JACC Heart Fail. 2019;7(8):637–47. https://doi.org/10.1016/j.jchf.2019.03.009.
Guan J, Khambhati J, Jones LW, Morgans A, Allaf M, Penson DF, et al. Cardiology patient page. ABCDE steps for heart and vascular wellness following a prostate cancer diagnosis. Circulation. 2015;132(18):e218–20. https://doi.org/10.1161/CIRCULATIONAHA.115.012521.
Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47. https://doi.org/10.1161/01.cir.97.18.1837.
• Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. The effectiveness of pharmacist interventions on cardiovascular risk: the multicenter randomized controlled RxEACH Trial. J Am Coll Cardiol. 2016;67(24):2846–54. https://doi.org/10.1016/j.jacc.2016.03.528 Findings from this study showcase the potential impact pharmacists could have by focusing on reducion of cardiovascular risk factors. Ultimately partenering with pharmacists for their expertise and accessibility could have important public health implications.
Macdonald S, Csiernik R, Durand P, Rylett M, Wild TC. Prevalence and factors related to Canadian workplace health programs. Can J Public Health. 2006;97(2):121–5.
• Gobis B, Kapanen AI, Reardon J, Min J, Li KH, Lynd LD, et al. Cardiovascular risk reduction in the workplace with CAMMPUS (Cardiovascular Assessment and Medication Management by Pharmacists at the UBC Site). Ann Pharmacother. 2019;53(6):574–80. https://doi.org/10.1177/1060028018823330 CAMMPUS trial highlights the importance of pharmacist involvement in the community and employer-based wellness clinics to improve outcomes and lower the risk of cardiovascular events with multiple benefits to patients and their employers.
Brindis R, Rodgers GP, Handberg EM. President's page: team-based care: a solution for our health care delivery challenges. J Am Coll Cardiol. 2011;57(9):1123–5. https://doi.org/10.1016/j.jacc.2011.02.003.
Dunn SP, Birtcher KK, Beavers CJ, Baker WL, Brouse SD, Page RL 2nd, et al. The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol. 2015;66(19):2129–39. https://doi.org/10.1016/j.jacc.2015.09.025.
Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009;169(19):1748–55. https://doi.org/10.1001/archinternmed.2009.316.
Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, et al. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923–33. https://doi.org/10.1097/MLR.0b013e3181e57962.
Padwal R, Rashead M, Snider J, Morrin L, Lehman A, Campbell NR. Worksite-based cardiovascular risk screening and management: a feasibility study. Vasc Health Risk Manag. 2017;13:209–13. https://doi.org/10.2147/VHRM.S138800.
Bright DR, Terrell SL, Rush MJ, Kroustos KR, Stockert AL, Swanson SC, et al. Employee attitudes toward participation in a work site-based health and wellness clinic. J Pharm Pract. 2012;25(5):530–6. https://doi.org/10.1177/0897190012442719.
John EJ, Vavra T, Farris K, Currie J, Doucette W, Button-Neumann B, et al. Workplace-based cardiovascular risk management by community pharmacists: impact on blood pressure, lipid levels, and weight. Pharmacotherapy. 2006;26(10):1511–7. https://doi.org/10.1592/phco.26.10.1511.
Parsons KA, Zimmermann AE. Impact of an ambulatory care pharmacist in an occupational health clinic. J Am Pharm Assoc (2003). 2019;59(1):64–9 e1. https://doi.org/10.1016/j.japh.2018.09.003.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Tracy E. Macaulay, Sarah Schaidle, and Nathan Wayne declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Ischemic Heart Disease
Rights and permissions
About this article
Cite this article
Macaulay, T.E., Schaidle, S. & Wayne, N. Cardiovascular Risk Reduction by Pharmacists at the Workplace. Curr Cardiol Rep 22, 15 (2020). https://doi.org/10.1007/s11886-020-1265-y
Published:
DOI: https://doi.org/10.1007/s11886-020-1265-y