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

Abstract

Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.ObjectiveTo evaluate the effect of a pharmacist-led intervention on CV risk in patients with inflammatory conditions.MethodsDesignProspective pre–postintervention.Setting17 community pharmacies across Alberta.PopulationAdults 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).InterventionAll 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.OutcomesPrimary: 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.ResultsWe 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.ConclusionThis 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 numberNCT03152396.