Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study
Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study
复制标题
临床药师干预对冠心病二级预防的影响：随机对照临床研究
DOI：
10.3389/fphar.2019.01112
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发表时间：
2019-10-08
影响因子：
5.6
通讯作者：
Dai, Haibin
中科院分区：
文献类型：
--
作者：
Xu, Huimin;Zou, Jie;Dai, Haibin
冠心病（CHD）是世界范围内发病率和死亡率的主要原因之一，应该付出更多努力来降低心血管事件的风险。本研究旨在探讨临床药师干预对中国冠心病患者急性冠脉综合征（ACS）预后的影响。研究招募了240名ACS患者。参与者被随机分为干预组（n = 120）和对照组（n = 120）。干预组在出院时接受临床药师的用药评估和教育，出院后1周和1、3个月接受电话随访。对照组接受常规护理。本研究的主要结局是发生主要不良心血管事件（mace）的患者比例，包括死亡率、非致死性心肌梗死（MI）、中风和出院后6个月和12个月内计划外的心脏相关再住院。次要结果是自我报告的冠心病循证药物治疗依从性（抗血小板、他汀类药物、受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂）。240例入组患者中，238例（98.3%）完成了6个月的随访，235例（97.9%）完成了12个月的随访。干预组与对照组在6个月随访期间（分别为3.3% vs 7.6%, P = 0.145）和12个月随访期间（分别为10.9% vs 12.1%, P = 0.783）发生mace的患者百分比差异无统计学意义。与对照组相比，干预组在出院时β受体阻滞剂和所有四类药物的处方率均有显著改善（P = 0.001和P = 0.009）。干预组与对照组在6个月随访时（分别为48.3%对45.8%,P = 0.691）和12个月随访时（分别为47.9%对46.6%,P = 0.836）四类药物的使用情况均无显著差异。干预组在6个月的随访（74.2% vs. 64.4%, P = 0.103）和12个月的随访（74.8% vs. 63.8%, P = 0.068）中β受体阻滞剂的使用均未显著高于对照组。临床药师干预对降低冠心病患者心血管事件无显著影响。进一步的研究需要更大的样本量和更长的干预和随访时间框架来验证临床药师在冠心病发病率和死亡率中的作用。
Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality worldwide, and more efforts should be made to reduce the risk of cardiovascular events. This study aimed to investigate the impact of clinical pharmacist intervention on the prognosis of acute coronary syndrome (ACS) in Chinese patients with CHD. Two hundred and forty patients who had ACS were recruited. Participants were randomly assigned to the intervention group (n = 120) or the control group (n = 120). The intervention group received a medication assessment and education by the clinical pharmacist at discharge and telephone follow-ups at 1 week and 1 and 3 months after discharge. The control group received usual care. The primary outcomes of this study were the proportion of patients who had major adverse cardiovascular events (MACEs), including mortality, nonfatal myocardial infarction (MI), stroke, and unplanned cardiac-related rehospitalizations within 6 and 12 months after hospital discharge. Secondary outcome was self-reported medication adherence to evidence-based medications for CHD (antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Of 240 enrolled patients, 238 (98.3%) completed 6-month follow-up, and 235 (97.9%) completed 12-month follow-up. There were no significant differences between intervention and control groups in the percentages of patients who incurred MACEs within the 6-month follow-up (3.3% vs 7.6%, respectively, P = 0.145) or 12-month follow-up (10.9% vs 12.1%, respectively, P = 0.783). Significant improvements were found in the prescribing rates of beta-blockers and all four classes of medications at discharge in the intervention group compared with the control group (P = 0.001 and P = 0.009, respectively). There was no significant difference between the intervention and control groups in the use of all four classes of medications at the 6-month follow-up (48.3% vs 45.8%, respectively, P = 0.691) and 12-month follow-up (47.9% vs 46.6%, respectively, P = 0.836). The use of beta-blockers was nonsignificantly higher in the intervention group than in the control group at the 6-month follow-up (74.2% vs. 64.4%, P = 0.103) and 12-month follow-up (74.8% vs 63.8%, P = 0.068). Clinical pharmacist intervention had no significant effects on reduction in cardiovascular events among patients with CHD. Further studies with larger sample sizes and longer time frames for both intervention and follow-up are needed to validate the role of the clinical pharmacist in the morbidity and mortality of CHD.