Impact of a pharmacist-led clinic in optimising lipid therapy for post-acute coronary syndromes (ACS) in high risk cardiovascular patients.

Abstract Introduction/Aims Approximately 25-28 % of UK CVD deaths are due to raised cholesterol; every 1.0 mmol/L in LDL is associated with a 23% relative risk reduction in major atherosclerotic CVD events. Patients merit high-intensity lipid-modifying therapy to maintain secondary prevention targets to reduce their risk of further disease or life threating events. In this study we aimed to evaluate the impact of a pharmacist led lipid optimisation clinic for secondary prevention in such patients. Method Following similar successful interventions elsewhere in the trust, a pharmacist led secondary prevention service covering post ACS patients was established. Four clinics were conducted weekly (2 clinics face to face and 2 clinics for reviews via telephone) delivered by a trained clinical pharmacist. Management was according to current national and local guidelines and patient prioritised according to CVD risk. Patients were reviewed in clinics, optimisation of medications including high intensity statins and commencing injectable lipid-lowering therapy if eligible and post- intervention monitoring carried out. Results Of 552 patients (M:F 400:187) mean age 69.0 (10.7) years, 527 (95%) on statins), 538 (98%) were above target of non-HDL of 2.5 mmol/L (mean 3.89 (1.11) mmol/L) and after initial optimisation by cardiology services 182 / 370 (49%) remained above target. Further optimisation in the specialist pharmacist led clinic led to led to a significant reduction in total cholesterol and non-HDL to a mean of 2.49 (0.99) mmol/L. Post pharmacist optimisation 77 out of 108 (71%) were at target O.R. 2.40 (1.51 – 3.82], p.001 of being at target equivalent to an NNT=5. Calculated LDL levels (Friedewald) show a mean additional reduction of 0.95 0.76 – 1.14 mmol/L due to the pharmacist led intervention. Conclusion A pharmacist-led service optimising lipid lowering therapy of secondary prevention for post ACS patients achieved significant reductions in LDL and non-HDL-C which will decrease the risk of developing further cardiovascular disease and prevent further life-threatening events.