Physician–Pharmacist PBPM for Intensive Lipid Management After Acute Myocardial Infarction

Q: What are the key findings of this study?

Physician-pharmacist PBPM increased evolocumab initiation at discharge vs physician-led care after AMI, though adjusted OR was 2.01.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=438). Intervention: Physician-pharmacist protocol-based pharmacotherapy management (PBPM) vs. Physician-led lipid-lowering protocol. Primary outcome: Evolocumab initiation at discharge (OR 2.01, 95% CI 0.94-4.29, p=0.008 (unadjusted); 0.071 (adjusted)).

Q: What does this research mean for the field?

A physician-pharmacist protocol-based pharmacotherapy management program increases evolocumab initiation at discharge and reduces system-related barriers compared to physician-led care after acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hiroya Aso; Riku Arai; So Iwabuchi; Toru Imai; Yuta Hotsubo; Tetsuro Nagao; Ran Sumida; Yudai Tanaka; Koichiro Hori; Katsunori Fukumoto; Yasunari Ebuchi; Suguru Migita; Keisuke Kojima; Mitsumasa Sudo; Yasuo Okumura

doi:10.5551/jat.66464

January 1, 2026Journal of Atherosclerosis and ThrombosisOpen Access

Physician–Pharmacist PBPM for Intensive Lipid Management After Acute Myocardial Infarction

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Key result

Physician-pharmacist collaborative care is linked to higher post-AMI evolocumab initiation at discharge vs physician-led care.

OR 2.01
95% CI 0.94-4.29
P=0.008 (unadjusted); 0.071 (adjusted)
n=438

Why the study?

Does a physician-pharmacist protocol-based pharmacotherapy management (PBPM) program increase evolocumab initiation at discharge and improve chronic-phase LDL-C control compared with a physician-led protocol in patients hospitalized for acute myocardial infarction undergoing PCI?

Key Points

To assess the effectiveness of a physician-pharmacist protocol-based pharmacotherapy management program compared with physician-led care in improving lipid-lowering therapy and LDL-C control after acute myocardial infarction.
Single-center observational study of 438 patients with acute myocardial infarction who underwent percutaneous coronary intervention and survived to discharge.
Evaluated patients across three consecutive eras: pre-protocol (n = 116), physician-led protocol (n = 160), and collaborative protocol-based pharmacotherapy management (PBPM, n = 162).
Assessed evolocumab initiation at discharge as the primary outcome and chronic-phase LDL-C as the key secondary outcome.
Evolocumab initiation rose across eras from 2.6% to 13.1% to 24.7% (overall P < 0.001) and was higher with PBPM than physician-led care (24.7% vs. 13.1%, P = 0.008), but the adjusted association was not statistically significant (OR 2.01, 95% CI 0.94–4.29, P = 0.071).
Chronic-phase LDL-C did not differ significantly between PBPM and physician-led care (49.0 vs. 51.5 mg/dL, P = 0.074), although achievement of LDL-C < 55 mg/dL was higher with PBPM (67.6% vs. 54.0%, P = 0.034).
Among protocol-eligible patients, evolocumab initiation increased from 40.0% to 61.0% (P = 0.047) and system-related non-initiation dropped from 44.4% to 4.3%.

Study Design

Type

Observational (n=438)

Blinding

Open-label

Multicenter

No

Structured PICO

Does a physician-pharmacist protocol-based pharmacotherapy management (PBPM) program increase evolocumab initiation at discharge and improve chronic-phase LDL-C control compared with a physician-led protocol in patients hospitalized for acute myocardial infarction undergoing PCI?

P

Population

438 patients (mean age 69.0 years, 24.2% female) with acute myocardial infarction who underwent PCI and survived to discharge across three consecutive practice eras, followed for a median of 184 days.

E

Exposure

Physician-pharmacist protocol-based pharmacotherapy management (PBPM) program during hospitalization (April 2025–May 2026), integrating pharmacists into day-2 LDL-C eligibility assessment, collaborative treatment discussion, order support, standardized patient education, self-injection training, and documentation. Evolocumab at discharge was recommended for day-2 LDL-C ≥90 mg/dL, ezetimibe 10 mg added for day-2 LDL-C 70 to <90 mg/dL, and maximally tolerated intensive statin therapy (rosuvastatin ≥10 mg/day, pitavastatin 4 mg/day, or atorvastatin ≥20 mg/day) continued for LDL-C <70 mg/dL.

C

Comparator

Physician-led lipid-lowering protocol era (October 2023–March 2025, n=160) as the prespecified primary comparator, utilizing the same day-2 LDL-C thresholds and intensive statin background therapy without structured pharmacist integration; and a pre-protocol era (October 2022–September 2023, n=116) as a supportive historical reference.

O

Outcome

Evolocumab initiation at hospital discharge.surrogate

Main Result

Odds Ratio: 2.01 (95% CI 0.94–4.29)

Absolute Event Rate: 24.7% vs 13.1%

p-value: p=0.008 (unadjusted); 0.071 (adjusted)

Limitations

Single-center retrospective observational design with historical comparators
Missing follow-up LDL-C data in approximately 21-25% of patients
Variability in the timing of chronic-phase LDL-C assessment
Exploratory analyses were not adjusted for multiplicity
Pharmacist intervention under PBPM was limited to the in-hospital setting

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Implication

Integrating pharmacists into an inpatient post-AMI lipid-lowering protocol via PBPM significantly increased protocol adherence, cut system-related non-initiation from 44.4% to 4.3%, and improved achievement of the <55 mg/dL chronic-phase LDL-C target.

Abstract

Aim : A physician-led lipid-lowering protocol increased early proprotein convertase subtilisin/kexin type 9 inhibitor use after acute myocardial infarction (AMI), but workflow barriers remained. We evaluated a physician-pharmacist protocol-based pharmacotherapy management (PBPM) program designed to address these limitations. Methods : This single-center observational study included 438 patients with AMI who underwent percutaneous coronary intervention and survived to discharge across PBPM ( n = 162), physician-led ( n = 160), and pre-protocol ( n = 116) eras. The prespecified primary comparison was PBPM versus physician-led care. The primary and key secondary outcomes were evolocumab initiation and chronic-phase low-density lipoprotein cholesterol (LDL-C), respectively. Exploratory analyses examined outcomes across day-2 LDL-C treatment flows. Protocol adherence and reasons for non-initiation were also assessed. Results : Evolocumab initiation increased across the pre-protocol, physician-led, and PBPM eras (2.6%, 13.1%, and 24.7%; overall P ＜0.001) and was more frequent with PBPM than physician-led care (24.7% vs. 13.1%, P = 0.008), although the adjusted association was nonsignificant (odds ratio 2.01, 95% confidence interval 0.94-4.29; P = 0.071). Chronic-phase LDL-C was 49.0 versus 51.5 mg/dL ( P = 0.074), whereas exploratory achievement of the contemporary LDL-C ＜55 mg/dL target was more frequent with PBPM (67.6% vs. 54.0%, P = 0.034). Among eligible patients, evolocumab initiation increased from 40.0% to 61.0% ( P = 0.047), while system-related non-initiation decreased from 44.4% to 4.3%. Exploratorily, chronic-phase LDL-C was lower with PBPM among patients with day-2 LDL-C ≥ 90 mg/dL (24 vs. 47 mg/dL; P = 0.011; interaction P = 0.010). Conclusions : PBPM was associated with greater adherence to the existing lipid-lowering protocol, more frequent evolocumab initiation at discharge, and fewer system-related reasons for non-initiation compared with physician-led care after AMI.

Discussion

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Cite This Study

Aso et al. (2026) conducted an observational in Acute myocardial infarction (n=438). Physician-pharmacist protocol-based pharmacotherapy management (PBPM) vs. Physician-led lipid-lowering protocol was evaluated on Evolocumab initiation at discharge (OR 2.01, 95% CI 0.94-4.29, p=0.008 (unadjusted); 0.071 (adjusted)). Physician-pharmacist PBPM increased evolocumab initiation at discharge vs physician-led care after AMI, though adjusted OR was 2.01.

synapsesocial.com/papers/6af74935cd1c85ac24395ce2 https://doi.org/10.5551/jat.66464

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Physician–Pharmacist PBPM for Intensive Lipid Management After Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Physician–Pharmacist PBPM for Intensive Lipid Management After Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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