Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic
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Hart, Matthew, Rees, Jon, Newton, Julia, Stansby, Gerard, Mackay, Kate and Luvai, Ahai (2024) Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic. Journal of Clinical Lipidology. ISSN 1933-2874 (In Press)
Item Type: | Article |
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Abstract
Background and Aims: Patients attending vascular or diabetic foot clinics commonly have atherosclerotic disease, are at increased risk of cardiovascular disease (CVD), merit high-intensity lipid-modifying therapy to maintain secondary prevention targets and are often sub optimally treated in primary care. We set out to assess the impact of a pharmacist led lipid optimisation clinic in these patients in an area with high levels of social deprivation.
Methods: We performed a clinical cohort study to assess the effectiveness of a pharmacist led clinic to optimise lipid lowering therapy by optimising of statin therapy and commencing additional lipid lowering therapy if applicable with monitoring of blood lipid profiles.
Results: Of the 216 patients (166 (77%) on statins) triaged by the pharmacist, 175 (81%) had non-HDL cholesterol levels above the target value of 97 mg/dL (2.5 mmol/L) with a mean non-HDL cholesterol level of 135.73 mg/dL (3.51 mmol/L). Pre optimisation by the prescribing clinical pharmacist 41/216 (19%) patients were at target with a mean non-HDL cholesterol of 135.5 mg/dL improving to 92/137 (67%) patients achieving the target non-HDL cholesterol level with a mean post optimisation non-HDL cholesterol of 94.35 mg/dL (2.44 mmol/L), odds ratio for being at target 8.67 [95% CI 5.30 – 14.20]. The calculated LDL cholesterol levels (Friedewald) demonstrated a mean reduction of 35.19 [95% CI 29.23 - 41.38] mg/dL (0.91 [95% CI 0.76 – 1.07] mmol/l). Proportion on high intensity statin increased from 65 out of 166 (39%) to 129 of 170 (76%) at follow up O.R. 4.89 [3.06 – 7.82], equivalent to an NNT = 3.
Conclusions: A pharmacist led service in undertreated and clinically challenging vascular and diabetic foot patients in an area of high social deprivation produced significant improvements in utilization of high intensity statin and other lipid lowering therapies and attainment of lipid goals.
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Depositing User: Jon Rees |
Identifiers
Item ID: 17546 |
Identification Number: https://doi.org/10.1016/j.jacl.2024.03.008 |
ISSN: 1933-2874 |
URI: http://sure.sunderland.ac.uk/id/eprint/17546 | Official URL: https://www.sciencedirect.com/science/article/pii/... |
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Catalogue record
Date Deposited: 19 Apr 2024 13:43 |
Last Modified: 19 Apr 2024 13:45 |
Author: | Matthew Hart |
Author: | Jon Rees |
Author: | Julia Newton |
Author: | Gerard Stansby |
Author: | Kate Mackay |
Author: | Ahai Luvai |
University Divisions
Faculty of Health Sciences and Wellbeing > School of PsychologySubjects
Sciences > Biomedical SciencesSciences > Pharmacy and Pharmacology
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Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic. (deposited 28 Mar 2024 13:47)
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