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Kari L. Olson, PharmD, BCPS; Jon Rasmussen, PharmD, BCPS; Brian G. Sandhoff, PharmD, BCPS; John A. Merenich, MD; for the Clinical Pharmacy Cardiac Risk Service (CPCRS) Study Group

Arch Intern Med. 2005;165:49-54.

Background  Published data indicate that there is a significant treatment gap between the evidence for and the implementation of lipid-lowering therapy and that recidivism is as high as 60% at 1 year. The aim of this study is to examine the impact of a clinical pharmacy cardiac risk service (CPCRS) on lipid screening, control, and treatment outcomes.

Methods  A computer-generated list of all patients with documented coronary artery disease, enrolled in a CPCRS between March 1, 1998, and October 1, 2002, and followed up for a minimum of 6 months was obtained. Outcome measures were the percentage of patients with up-to-date lipid screening results and the percentage achieving low-density lipoprotein cholesterol (LDL-C) goals at enrollment in CPCRS and at study end.

Results  A total of 8014 patients (mean age, 69.3 years; 69.8% men) met the entry criteria. The mean duration of follow-up was 2.3 years. Most patients (97.3%) had up-to-date lipid screening results at study end compared with 66.9% of patients at baseline. At study end, a total of 72.9% of patients achieved a LDL-C level of less than 100 mg/dL (<2.6 mmol/L) compared with 25.5% at baseline. The mean ± SD LDL-C level for the cohort at study end was 89 ± 24 mg/dL (2.3 ± 0.6 mmol/L). Of patients receiving medication, most (84.8%) were receiving therapy with statins alone, whereas 11.7% were receiving combination therapy.

Conclusions  A CPCRS working in conjunction with a patient-tracking system can achieve improved lipid results in a large and inclusive cohort of patients with coronary artery disease. Our approach is unique in that the results were sustainable and demonstrate reduced recidivism.

Author Affiliations : Departments of Pharmacy (Drs Olson, Rasmussen, and Sandhoff) and Endocrinology (Dr Merenich), Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado Region, Aurora; and University of Colorado Health Sciences Center, Denver (Drs Olson, Rasmussen, Sandhoff, and Merenich).

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