Pharmacist intervention helps improve outcomes in stroke patients

Admitted patients with a cerebrovascular accident (stroke) or transient ischaemic attack (TIA) who received pharmacist intervention in the stroke prevention clinic (SPC) are less likely to be readmitted and more likely to show improvement in surrogate markers, such as blood pressure (BP) and haemoglobin (Hb)A1c, a study has shown.

“Hospital readmissions for the primary composite endpoint of secondary stroke/TIA, myocardial infarction (MI), and new or incidental peripheral artery disease (PAD) were improved in the SPC group,” the researchers said. “This indicates that pharmacists can play a role in improving outcomes in the poststroke/TIA patient population.”

This retrospective cohort study evaluated patients with a stroke or TIA at Temple University Hospital (TUH) who were referred to the SPC from October 2012 to December 2014. TUH is a large tertiary care academic teaching hospital in the US, which cares for approximately 800 new strokes annually.

Risk factor data was obtained at the time of stroke/TIA, before initial visit and after last SPC visit. Hospital readmissions were also reviewed for secondary stroke/TIA, MI, and new or incidental PAD. Data for patients who did not attend the SPC was used as a control.

A total of 455 records were reviewed. Patients referred to the SPC had statistically significantly lower readmission for stroke/TIA, MI, and new or incidental PAD than controls (p=0.013). This amounted to a 43.4-percent relative risk reduction, a 7.4-percent absolute risk reduction and a number needed to treat of 14. [J Pharm Pract 2019;32:503-508]

Hospital admissions for stroke/TIA were fewer by 4 percent, for MIs by 1.71 percent and for PAD by 1.63 percent among patients who visited the SPC as compared to those who did not. The SPC group also showed improvements in all surrogate markers, including BP, low-density lipoprotein (LDL) cholesterol, HbA1c and smoking status.

“These results demonstrate that pharmacists in the SPC at TUH reduce patient modifiable risk factors for secondary stroke/TIA and can prevent future hospital admissions,” the researchers said. “Additional data are needed to determine whether baseline factors such as type of stroke and/or comorbidities impact these results.”

A meta-analysis of 30 randomized controlled trials involving 11,765 patients also demonstrated that pharmacists can improve patient outcomes. Results showed improvements in BP, total cholesterol and LDL cholesterol and a reduction in smoking rates when managed by a pharmacist. [Arch Intern Med 2011;171:1441-1453]

“However, this is the first description of pharmacist management of secondary stroke risk factors in a stroke clinic in the United States,” the researchers said. “Our findings are consistent with the publications in Canada and Taiwan that pharmacists can play a role in the poststroke care of patients.” [Can J Hosp Pharm 2008;61:431-436; CMAJ 2014;186:577-584; J Clin Pharm Ther 2008;33:529-535]

Further research is warranted to assess specific intervention, such as medication initiation and dose adjustment, to determine which strategies are associated with the best outcomes, they noted.