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Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic
Matthew Hart1, Jon Rees2, Julia L Newton3
1Pharmacy, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE7 7DN, UK (Dr Hart).
Insights
Pharmacist-led clinics significantly improved lipid-lowering therapy in high-risk patients with atherosclerotic disease. This intervention optimized statin use and increased the number of patients achieving lipid goals, enhancing cardiovascular disease prevention.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Patients in vascular or diabetic foot clinics often have atherosclerotic disease and a high risk of cardiovascular disease (CVD).
- These patients require high-intensity lipid-modifying therapy for secondary prevention but are frequently undertreated in primary care.
- Social deprivation can exacerbate health disparities in managing chronic conditions like atherosclerotic disease.
Purpose of the Study:
- To evaluate the effectiveness of a pharmacist-led lipid optimization clinic.
- To assess the impact on lipid-lowering therapy, particularly statin use, in high-risk patients.
- To determine if the intervention improves achievement of lipid targets in an area with high social deprivation.
Main Methods:
- A clinical cohort study was conducted.
- Pharmacist-led interventions focused on optimizing statin therapy and initiating additional lipid-lowering medications.
- Monitoring of blood lipid profiles was performed to assess treatment effectiveness.
Main Results:
- Initially, 81% of patients had non-high-density lipoprotein (non-HDL) cholesterol above the target of 97 mg/dL.
- After pharmacist intervention, the proportion of patients achieving the non-HDL cholesterol target increased from 19% to 67%.
- The use of high-intensity statins rose significantly, and low-density lipoprotein cholesterol levels showed a mean reduction.
Conclusions:
- A pharmacist-led service effectively improved the utilization of high-intensity statins and other lipid-lowering therapies.
- The intervention led to significant improvements in achieving lipid goals among clinically challenging patients.
- This model demonstrates success in managing lipid levels in underserved populations with atherosclerotic disease.
Abstract:
Patients attending vascular or diabetic foot clinics commonly have atherosclerotic disease, are at increased risk of cardiovascular disease (CVD), merit high-intensity lipid-modifying therapy to maintain secondary prevention targets and are often sub optimally treated in primary care. We set out to assess the impact of a pharmacist led lipid optimisation clinic in these patients in an area with high levels of social deprivation.
Methods:
We performed a clinical cohort study to assess the effectiveness of a pharmacist led clinic to optimise lipid lowering therapy by optimising of statin therapy and commencing additional lipid lowering therapy if applicable with monitoring of blood lipid profiles.
Results:
Of the 216 patients (166 [77%] on statins) triaged by the pharmacist, 175 (81%) had non-high-density lipoprotein (non-HDL) cholesterol levels above the target value of 97 mg/dL (2.5 mmol/L) with a mean non-HDL cholesterol level of 135.73 mg/dL (3.51 mmol/L). Pre optimisation by the prescribing clinical pharmacist 41/216 (19%) patients were at target with a mean non-HDL cholesterol of 135.5 mg/dL improving to 92/137 (67%) patients achieving the target non-HDL cholesterol level with a mean post optimisation non-HDL cholesterol of 94.35 mg/dL (2.44 mmol/L), odds ratio (OR) for being at target 8.67 (95% CI 5.30-14.20). The calculated low-density lipoprotein cholesterol levels (Friedewald) demonstrated a mean reduction of 35.19 (95% CI 29.23-41.38) mg/dL (0.91 [95% CI 0.76-1.07] mmol/L). Proportion on high intensity statin increased from 65 out of 166 (39%) to 129 of 170 (76%) at follow up (OR 4.89 [3.06-7.82]), equivalent to an number needed to treat = 3.
Conclusions:
A pharmacist led service in undertreated and clinically challenging vascular and diabetic foot patients in an area of high social deprivation produced significant improvements in utilization of high intensity statin and other lipid lowering therapies and attainment of lipid goals.
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