Joseph Saseen, PharmD, BCPS, BCACP
Professor and Vice Chair, Clinical and Academic Programs; Department of Clinical Pharmacy
Professor; Department of Family Medicine
Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus
Chair, BPS Cardiology Pharmacy Specialty Council
February was American Heart Month! It was the perfect time to reflect on what we can do as board certified pharmacists to improve patient care. Heart disease continues to be the #1 cause of death in the United States. Because this has been the case for decades, we have the luxury of having many evidence-based drug therapies for treatment and prevention of cardiovascular disease.
The American College of Cardiology and American Heart Association provide recommendations in their guidelines1 that highlight the proven benefits of team-based care. Clinical pharmacists are included in their definition of team. For example, their 2017 hypertension guideline recommends a team-based care approach for adults with hypertension (class 1, level of evidence A recommendation). Pharmacists are “called out” as members of this team that complement the activities of the primary care provider by providing process support and sharing the responsibilities of hypertension care. These guidelines cite evidence that promote important implementation aspects of team-based care, and specifically identify the role of team members related to medication management to inﬂuence blood clinical outcomes. Similarly, the 2018 cholesterol guideline2 recommends team-based care and inclusion of pharmacists. They specifically identify pharmacist-led interventions as a recommended management strategy (class 1, level of evidence A recommendation).
The healthcare landscape is ripe for clinical pharmacists to take a bigger role in direct patient care for the treatment and prevention of cardiovascular disease. The evidence is robust, the need for intervention is clear, and the workforce of clinical pharmacists is prepared. Pharmacists that are board certified through the Board of Pharmacy Specialists have proven that they have experience via their qualifications, and have the requisite knowledge to provide advanced patient care. Specifically, Board Certified Cardiology Pharmacists focus on disease prevention and treatment, including evidence-based medication use and related care that improve both short- and long-term outcomes for patients. Board Certified Ambulatory Care Pharmacists also are involved in this space, by providing integrated, accessible healthcare services for ambulatory patients and so are many Board Certified Pharmacotherapy Specialists.
We have several problems related to healthcare in the United States. One of them is that medications that are proven to improve cardiovascular outcomes are either underutilized or not optimized in our patient populations. Board Certified Pharmacists with expertise in cardiology are part of the solution. As a profession, pharmacists need to push forward to advance our clinical roles and to be active participants. This does not happen without effort and willingness to accept risk. However, we, as a collective group, are capable of this challenge. If we stand by and wait for our roles to evolve they will not, and we will be part of the problem.
1 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. September 10, 2019. http://www.onlinejacc.org/content/accj/74/10/e177.full.pdf?_ga=2.10299573.1048589258.1583757128-1886572990.1583757128
2 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.November 10, 2018. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625