|Year : 2016 | Volume
| Issue : 1 | Page : 6-7
The care of patients with cardiovascular disease: Pharmacists role
Teresa Pounds1, Cynthia Iyekegbe2
1 Department of Clinical Pharmacy, Wellstar Atlanta Medical Center; Mercer University College of Pharmacy, Atlanta, GA, USA
2 Mercer University College of Pharmacy, Atlanta, GA, USA
|Date of Web Publication||25-Jul-2016|
Wellstar Atlanta Medical Center, 303 Parkway Dr NE, Atlanta, GA 30312
Source of Support: None, Conflict of Interest: None
The field of pharmacy and the role of pharmacists have expanded remarkably within the past thirty years. Clinical pharmacists' postgraduate educational training has prepared them to be competent in patient-centered care and pharmacy operational services that can be applied to any practice setting including specialized fields of clinical pharmacy such as infectious diseases and anticoagulation. Studies have also revealed the impact of clinical pharmacists on medication error reduction within the pediatric and adult critical care units, improved nutritional status in hematopoietic stem cell transplant patients, and reduced readmission rates of patients with heart failure. Highlights of selected literature showcase the role clinical pharmacists' play within the multidisciplinary team and its significant impact on both clinical and economical outcomes.
Keywords: Cardiovascular disease, patient care, pharmacists role
|How to cite this article:|
Pounds T, Iyekegbe C. The care of patients with cardiovascular disease: Pharmacists role. Niger J Cardiovasc Thorac Surg 2016;1:6-7
| Introduction|| |
The field of pharmacy and the role of pharmacists have expanded remarkably within the past thirty years. This paper will discuss the training, certification, and role of clinical pharmacists in the team-based approach of provisional care to cardiovascular patients in an era where cardiologist and cardiovascular surgeon shortage necessitates utilization of nonpractitioners. Selected review articles highlighting the benefit of clinical pharmacists will also be discussed.
In a review article, Dunn et al. stated that due to the shortage of cardiologists and cardiovascular surgeons, "team-based approach as a means to address the growing cardiovascular disease (CVD) epidemic" has been endorsed by the American College of Clinical Pharmacy (ACCP) Board of Trustees and Strategic Plan.  Collaboration with nonphysician providers, including clinical pharmacists, is an efficient and cost-effective means of improving patient outcomes. Clinical pharmacy is a sector of pharmacy focused in the sciences and practice of rational medication use, in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.  Postgraduate education and training differ for a cardiovascular clinical pharmacist from that of clinical pharmacists working in other settings. Upon graduation from an accredited ACPE School of Pharmacy, a Postgraduate Year-1 (PGY-1) Residency-Training Program is completed to produce pharmacy practitioner competence in patient-centered care and pharmacy operational services.  Clinical pharmacists desiring to specialize in the cardiovascular area will complete a PGY-2 residency in cardiology to obtain training in the care of patients that is both from a preventive and a treatment perspective. These individuals are also exposed to training in other areas such as clinical research, quality improvement initiatives, leadership, pharmacy management, teaching, and educational activities. 
| Cardiovascular Disease and the Role of Pharmacists|| |
CVD represents many disorders such as arrhythmias and coronary heart disease that involves heart and blood vessels. Treating these conditions is very complicated, which leads to clinical under prescribing practices in this patient population.  Clinical pharmacists with expertise in medication therapy management of CVD provide a variety of both inpatient and outpatient services that are patient-, facility-, and global-specific.  Examples of patient-specific services are patient education, pharmacokinetic dosing, pharmacodynamics dosing, and collaborative practice agreements. Other services such as formulary management and financial stewardship along with societal guideline and policy development add to the list of services clinical pharmacists perform.
Polypharmacy within the population of CVD patients has caused high risks of medication errors and adverse drugs events. "Clinical pharmacists are uniquely positioned to address medication safety due to their intimate understanding of the medication use process and clinical pharmacology."  The impact of clinical pharmacists within the multidisciplinary Intensive Care Unit (ICU) rounding team in cardiac surgery ICUs was evaluated by a group of researchers. Al-Jazairi et al. assessed the medical team acceptance of interventions, frequency of clinical pharmacist involvement, clinical significance of interventions, and targeted patient outcomes. Results revealed a 94% acceptance rate from the medical team when clinical pharmacists made interventions.  The common interventions noted were as followed: "no drug prescribed for medical condition," "inappropriate dosing regimen," and "no indication for drug use." Over 50% of the interventions resulted in the enhancement of therapeutic outcomes while 25% resulted in the prevention of adverse drug events. 
Heart failure is associated with an increased risk of morbidity and mortality consequently, resulting in an increase of healthcare cost.  A recent study by McNeely revealed the impact clinical pharmacists make to reduce health-care cost and improve disease management as patients transition from inpatient to outpatient care. Interventions are focused on the development of patient care plans, education of patients and clinicians, prevention of adverse drug reaction, reconciliation of medications, monitoring of drugs levels, and the development of strategies to improve medication access and adherence. It was concluded that education was a key area, in which clinical pharmacists can improve care to patients with heart failure and should not be limited to only patients but also to all members of the health-care team. 
Nutritional support is imperative for patients in the critical care setting including patients with heart disease. Total parenteral nutrition (TPN) is proven to speed patient recovery and increase health outcomes.  A multidisciplinary approach is utilized when providing nutritional support to patients. This team is comprised dietitians, physicians, nurses, and nutritional support board-certified pharmacists.  These pharmacists play an essential role in determining patients' need of a TPN, assuring appropriateness, composition, and quality.  Nutritional support pharmacists are involved in every aspect of patients' parental nutrition including type of feeding design, dose-specific nutrients, clinical monitoring, and patients' safety.
Mousavi et al. compared clinical pharmacist-based parenteral nutrition formulation to conventional method (absence of clinical pharmacists) in adult patients undergoing hematopoietic stem cell transplants. Nutritional status, length of hospital stay, and mortality rate were the main outcomes evaluated in the study. Results revealed clinical pharmacist-based nutrition support service significantly improved nutritional status and clinical outcomes in comparison with the conventional method.  Length of hospital stay decreased and nutritional status improved in patients who received pharmacists-based parenteral nutrition therapy.
A 2009 ACC survey demonstrated that many cardiologists and cardiovascular surgeons are unfamiliar with how to best apply a nonphysician team approach to patient care.  However, it is important to note that major application of a clinical pharmacist to direct patient care is team centric and not independent to physician or other license providers. "There is no doubt that today's advanced medications save lives, improve quality of life, and prevent more serious illness."  Globally, clinical pharmacists are on the front lines in preventive care and treatment. Clinical pharmacists work with providers to select and monitor the correct medication for patients as well as ensuring manageable side effects and affordability of treatment. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American College of Clinical Pharmacy. Standards of Practice for Clinical Pharmacists; 2004. Available from:
. [Last accessed on 2016 May 31].
Dunn SP, Birtcher KK, Beavers CJ, Baker WL, Brouse SD, Page RL 2 nd
, et al.
The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol 2015;66:2129-39.
Al-Jazairi AS, Al-Agil AA, Asiri YA, Al-Kholi TA, Akhras NS, Horanieh BK. The impact of clinical pharmacist in a cardiac-surgery intensive care unit. Saudi Med J 2008;29:277-81.
Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: A systematic review of randomized trials. Arch Intern Med 2008;168:687-94.
McNeely E. Treatment considerations and the role of clinical pharmacists throughout transition of care for patients with acute heart failure. J Pharm Pract 2016;10;1-10.
Cheng JW, Cooke-Ariel H. Pharmacists′ role in the care of patients with heart failure: Review and future evolution. J Manag Care Pharm 2014;20:206-13.
News Team. All hospitals administering parenteral nutrition should include pharmacist in nutrition team. Pharmaceutical J 2010;285;3. Available from:
. [Last accessed on 2016 May 31].
Mousavi M, Hayatshahi A, Sarayani A, Hadjibabaie M, Javadi M, Torkamandi H, et al.
Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients: A randomized clinical trial. Support Care Cancer 2013;21:3441-8.