Patients with peripheral arterial disease often are undertreated with regard to atherosclerotic risk factor modification. Such patients can benefit from the use of a clinical pharmacy service in conjunction with physician recommendations for lipid control, according to Dr. Thomas F. Rehring and colleagues from the Kaiser Permanente Colorado Region and the University of Colorado Health Sciences Center in Denver.
In a cohort of 691 outpatients with peripheral arterial disease (PAD) validated by noninvasive arterial study, 90 patients were enrolled into a pharmacist-managed, physician-monitored algorithmic approach for the management of lipids, and 601were given standard care, according to Dr. Rehring, of the vascular surgery department at Kaiser Permanente, and his colleagues. They presented the results of their research at the annual meeting of the Western Vascular Society in Deer Valley, Utah.
Low-density lipoprotein cholesterol (LDL-C) control goals were achieved by a significantly greater percentage of the pharmacist-managed group (79%) than the standard treatment group (54%). And a significant difference in the number of patients with LDL-C values over 130 mg/dL was noted between the treatment (1.2%) and control (14%) groups. In the control group, nearly 52% of patients used statins, compared with 84% of the pharmacist-managed group, a statistically significant difference.
All patients in the study were members of a not-for-profit managed care system serving about 405,000 patients. Full outpatient records of medical, pharmacy, laboratory, and radiology information were stored electronically, allowing for “current and comprehensive analysis,” according to the researchers.
Mean follow-up was slightly more than 17 months. Fasting lipid profiles were screened in 95% (86/90) of the patients in the algorithmic group and nearly 67% (402/601) of the standard care group.
All patients accepting enrollment in the algorithmic approach interacted regularly with a pharmacist-manager who collected data, monitored medication and laboratory compliance while making treatment plan adjustments, and kept the responsible primary care physician notified. Lipid control goals were those defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines.
“Our current study demonstrates that improvements in lipid control and statin usage, and attainment of national lipid goals, are highly achievable in a PAD population that is treated in a disease management fashion,” the researchers stated.