Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study

2020 ◽  
pp. 089719002095824
Author(s):  
Dakota L. Freudenberg ◽  
Les P. Covington ◽  
Rodney B. Young ◽  
Nicole D. Lopez ◽  
Miti V. Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Pharmacist ◽  
Diabetes Management ◽  
System Level ◽  
Atherosclerotic Cardiovascular Disease ◽  
Inclusion Criteria ◽  
Post Intervention ◽  
Patient Outreach ◽  
Risk Reducing ◽  
Service Presentation

Purpose: To determine whether a pharmacist-driven protocol improves guideline-concordant prescribing of diabetes medications in patients with atherosclerotic cardiovascular disease (ASCVD). Methods: A retrospective pre- and post-intervention study was conducted at a university-based family medicine clinic. A pharmacist-driven protocol was implemented which involved the creation of an algorithm recommending specific diabetes medications in patients with ASCVD. An in-service presentation reviewing the algorithm and process for referral of eligible patients to an appointment with a clinical pharmacist was delivered to providers. Clinical pharmacist appointments focus was on improving diabetes management and initiating cardiovascular risk-reducing medications if appropriate. Results: A total of 234 patients were screened, and 108 met inclusion criteria. Upon completion of patient outreach, 34% were scheduled with a pharmacist. Forty-three percent of patients (16 of 37) attended the appointment. Of those, 31% were initiated on an evidence-based regimen indicated for diabetes and ASCVD. In comparing pre- to post-implementation of the pharmacist-driven protocol, the rate of guideline-concordant prescribing increased by 48% (3.8% to 5.6%). Conclusion: Implementation of a pharmacist-driven protocol can increase guideline-concordant prescribing. However, further exploration of patient- and system-level barriers is necessary to implement such a program more broadly.

scholarly journals Effect of DASH Diet Versus Healthy Dietary Advice on the Estimated Atherosclerotic Cardiovascular Disease Risk

2021 ◽  
Vol 12 ◽  
pp. 215013272098095
Author(s):  
Marwa S. Said ◽  
Inas T. El Sayed ◽  
Eman E. Ibrahim ◽  
Ghada M. Khafagy
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Dietary Advice ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Post Intervention ◽  
Dash Diet ◽  
Significant Difference ◽  
Diet Versus

Introduction: Cardiovascular disease (CVD) is the most leading cause of mortality worldwide. Changes in diet can reduce subclinical cardiac injury and inflammation in parallel with reductions of other CVD risk factors. Aim: The study aimed to evaluate the beneficial effect of the DASH diet versus usual healthy dietary advice (HDA) on the estimated risk of atherosclerotic cardiovascular disease (ASCVD). Methods: It was a prospective interventional nonrandomized controlled study, conducted on 92 participants attending Family Medicine Outpatient Clinics, Cairo University. The participants were assigned to 2 dietary groups, the DASH and HDA groups, for 12 weeks. All subjects were subjected to anthropometric measurement, assessment of lipid profile, and the estimated cardiovascular risk pre-and post-intervention. Results: The estimated cardiovascular risk was reduced significantly in both the DASH and HDA groups, with no statistically significant difference between the 2 groups regarding the risk reduction. By comparing the percent change between pre and post-intervention in both DASH and HDA groups, the following are the results: BMI dropped by 6.5% versus 2.5%, systolic blood pressure decreased by 6.9% and 4.1%, fasting blood sugar dropped by 5.5% and 3.1%, total cholesterol dropped by 5.2% and 3.1%, LDL dropped by 8.2%, and 3.1%, and HDL increased by 8.2% and 2.4%, in DASH and HDA groups, respectively. Conclusion: Both the DASH diet and HDA are associated with improvement in CVD risk factors. Although better risk factors decline with the DASH diet, there was no statistically significant difference between the 2 groups.

scholarly journals Cardiovascular event rates in a high atherosclerotic cardiovascular disease risk population: estimates from Swedish population-based register data

2019 ◽  
Vol 5 (3) ◽  
pp. 225-232 ◽  
Author(s):  
Maria Lindh ◽  
Jonas Banefelt ◽  
Kathleen M Fox ◽  
Sara Hallberg ◽  
Ming-Hui Tai ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Real World ◽  
Disease Risk ◽  
Population Based ◽  
Moderate Intensity ◽  
Atherosclerotic Cardiovascular Disease ◽  
Inclusion Criteria ◽  
Prevalent Cohort ◽  
Event Rates ◽  
Incident Cohort

Abstract Aims This study aimed to estimate the rate of cardiovascular (CV) events in the real world in patients at high risk of recurrent CV events similar to the FOURIER trial population. Methods and results A retrospective population-based cohort study was conducted using Swedish national registers from 1 July 2001 to 31 December 2015. Patients in the atherosclerotic cardiovascular disease (ASCVD) prevalent cohort met the FOURIER-like inclusion criteria, including treatment with high/moderate-intensity statins, on 1 July 2006. Additionally, two cohorts defined by diagnosis of incident ischaemic stroke (IS) and incident myocardial infarction (MI), meeting the FOURIER-like inclusion criteria were followed from date of diagnosis. Event rates were calculated for the hard major adverse cardiovascular events (MACE) composite: MI, IS, and CV death; and the ASCVD composite: MI, IS, unstable angina, coronary revascularization, and CV death. Approximately half of patients experienced a CV event (ASCVD composite) during follow-up. The MACE composite rates/100 person-years were 6.3, 11.9, and 12.3 in the ASCVD prevalent (n = 54 992), MI incident (n = 45 895), and IS incident (n = 36 134) cohorts, respectively. The ASCVD composite rates/100 person-years were 7.0, 21.7, and 12.9 in the ASCVD prevalent, MI incident, and IS incident cohorts, respectively. The multiple-event MACE composite rates/100 person-years were 8.5 (ASCVD prevalent cohort), 15.4 (MI incident cohort), and 14.4 (IS incident cohort). Conclusion In this real-world setting, CV event rates were high in all studied cohorts. In particular, the MACE composite rates were two to three times higher than in the FOURIER clinical trial, indicating a substantial disease burden despite treatment with moderate or high-intensity statins.

scholarly journals Lessons Learnt Implementing a Cardiovascular Disease Quality Improvement Intervention in Australian Primary Care: A Mixed Method Evaluation

2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Katrina Giskes ◽  
Mark Harris ◽  
David Peiris
Keyword(s):  
Cardiovascular Disease ◽  
Quality Improvement ◽  
Waist Circumference ◽  
Smoking Status ◽  
External Support ◽  
Normalisation Process Theory ◽  
Quality Improvement Intervention ◽  
Post Intervention ◽  
Risk Reducing ◽  
Depth Interviews

Abstract Background There are discrepancies between evidence-based guidelines for screening and management of cardiovascular disease (CVD) and implementation in Australian general practice. Quality-improvement (QI) initiatives aim to reduce these gaps. This study evaluated a QI intervention (QPulse) that focussed on CVD assessment and management. MethodsThis mixed-methods study explored the implementation of guidelines and adoption of QI processes in 34 general practices. CVD screening and management were measured pre- and post-intervention. Qualitative analyses examined participants’ Plan-Do-Study-Act (PDSA) goals and in-depth interviews with practice stakeholders focussed on barriers and enablers to implementation and were analysed thematically using Normalisation Process Theory (NPT). ResultsPre- and post-intervention data were available from 15 practices (n=19562 and n=20249, respectively) and in-depth interviews from seven practices. At baseline, 45.0% of patients had their BMI measured and 15.6% had their waist circumference recorded in the past 2 years and blood pressure, lipids and smoking status were measured in 72.5%, 61.5% and 65.3% of patients, respectively. Most high-risk patients (57.5%) were not prescribed risk-reducing medications. After the intervention there were no changes in the documentation and prevalence of risk factors, attainment of BP and lipid targets or prescription of CVD risk-reducing medications. However, there was variation in performance across practices with some showing isolated improvements, such as recording waist circumference (0.7-32.2% pre-intervention to 18.5%-69.8% post-intervention), BMI and smoking assessment. Challenges to implementation included: lack of time, need for technical support, a perceived lack of value for quality improvement work, difficulty disseminating knowledge across the practice team, tensions between the team and clinical staff and a part-time workforce. ConclusionThe implementation barriers associated with this QI program was considerable in Australian GP practices. Findings highlighted they were not able to effectively operationalise the intervention due to numerous factors, ranging from lack of internal capacity and leadership to competing demands and insufficient external support. Trial registrationAustralian New Zealand Clinical Trials Reference Number (ACTRN12615000108516), registered 06/02/2015. Trial protocol can be accessed at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000108516

Pigment Epithelium-Derived Factor: A Novel Therapeutic Target for Cardiometabolic Diseases and Related Complications

2018 ◽  
Vol 25 (13) ◽  
pp. 1480-1500 ◽  
Author(s):  
Sho-ichi Yamagishi ◽  
Takanori Matsui
Keyword(s):  
Cardiovascular Disease ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Visceral Obesity ◽  
Retinal Pigment Epithelial Cells ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiometabolic Diseases ◽  
The Metabolic Syndrome ◽  
Pigment Epithelium Derived Factor ◽  
Cardiometabolic Disorders

Pigment epithelium-derived factor (PEDF) is a glycoprotein that belongs to the superfamily of serine protease inhibitors, serpins. It was first identified as a neuronal differentiating factor secreted by human retinal pigment epithelial cells, and then found to be the most potent inhibitor of pathological angiogenesis in mammalian eyes. Recently, PEDF has been shown not only to suppress oxidative stress and inflammatory reactions in vascular wall cells, T cells and macrophages, and adipocytes, but also to exert antithrombotic and anti-fibrotic properties, thereby protecting against the development and progression of various cardiometabolic diseases and related complications. Furthermore, accumulating evidence has suggested that circulating PEDF levels may be a biomarker of severity and prognosis of these devastating disorders. Number of subjects with visceral obesity and insulin resistance is increasing, and the metabolic syndrome and its related complications, such as diabetes, nonalcoholic fatty liver disease/non-alcoholic steatohepatits, and atherosclerotic cardiovascular disease are a growing health challenge. Therefore, in this study, we review the pathophysiological role of PEDF in obesity and metabolic disorders, cardiovascular disease, diabetic eye and kidney complications, liver diseases, and reproductive system disorders, and discuss the potential clinical utility of modulating the expression and actions of PEDF for preventing these cardiometabolic disorders. We also refer to the clinical value of PEDF as a biomarker in cardiometabolic complications.

Plant n-3 PUFA intake may lower the risk of atherosclerotic cardiovascular disease only among subjects with a low intake of marine n-3 PUFAs

2021 ◽  
Author(s):  
Christian S. Bork ◽  
Søren Lundbye-Christensen ◽  
Stine K. Venø ◽  
Anne N. Lasota ◽  
Erik B. Schmidt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Atherosclerotic Cardiovascular Disease ◽  
Pufa Intake

Atherosclerotic Cardiovascular Disease in Individuals with Hepatitis C Viral Infection

2021 ◽  
Vol 23 (5) ◽  
Author(s):  
Alison L. Bailey ◽  
Saif Al-Adwan ◽  
Eliea Sneij ◽  
Nicholas Campbell ◽  
Matthew E. Wiisanen
Keyword(s):  
Cardiovascular Disease ◽  
Hepatitis C ◽  
Viral Infection ◽  
Atherosclerotic Cardiovascular Disease
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