Impact of a Cardiovascular Pharmacist Early Review in a Multi-disciplinary Clinic for Patients after Percutaneous Coronary Intervention

Introduction: Percutaneous coronary intervention (PCI) is the predominant method of revascularization for patients with ischemic heart disease.  Our tertiary hospital in Singapore perform approximately 1300 cases annually.  These patients were routinely reviewed by a cardiologist in a post-PCI clinic within 8 weeks.  A multi-disciplinary clinic was formed in October 2011, with the cardiovascular (CVS) pharmacist review within 4 weeks as the first visit.

Objectives: This study evaluated the impact of having a CVS pharmacist early review compared to standard care.

Study Design: This was a retrospective cohort study with one-year follow up.

Methods: Patients with recent PCI, reviewed by the CVS pharmacist from October 2011 to June 2012 were studied.  Patients in the preceding months from April to August 2011 (matched by baseline clinical characteristics) formed the control group.  End-points analyzed included hospital readmission rates, initiation of essential medications, Low-Density Lipoprotein (LDL) and Glycated hemoglobin (HbA1c) levels.

Results: Of the 193 patients in each group, 30-day readmission was 4.7% in the pharmacist group and 9.3% in the control group (p=0.072).  One-year CVS readmission was significantly lower (10.9% vs 19.2%, p=0.023) in the pharmacist group.  Patients enrolled in the pharmacist group were more likely to be initiated on a beta-blocker (64.7% vs 20%, p<0.01), and an ACE-inhibitor (68.8% vs 26.1%, p<0.01) during the first clinic visit.  The pharmacist group had a greater reduction in LDL (1.33±1.21mmol/dL vs 0.89±1.12mmol/dL, p<0.01) and HbA1c (2.19±2.26% vs 1.25±0.92%, p=0.038) levels.

Conclusions: This study suggests that having a CVS pharmacist early review post-PCI can potentially reduce CVS readmission rates, result in higher rate of initiation of beta-blocker and ACE-inhibitor, and improve control of dyslipidemia and diabetes mellitus.