Improving CVD Outcomes Through Better Recommendations, Patient Monitoring

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Researchers detailed the FDA’s recommendations on low-dose aspirin and pharmacists’ role in cardiovascular practice transformation programs.

Researchers examined pharmacists’ role in cardiovascular practice transformation (CPT) and compared conflicting aspirin guidelines between the FDA and American Diabetes Association (ADA). Findings were presented in 2 posters at the 2024 American Pharmacists Association Annual Meeting and Exposition.

“[The CPT] program was designed to guide community pharmacies in implementing changes to support longitudinal monitoring of patients with cardiovascular conditions such as hypertension,” wrote Alhersh et al.1

Key Takeaways

  • Researchers addressed the role of pharmacists in improving outcomes for patients with hypertension and addressed ADA and FDA guideline discrepancies.
  • Pharmacists showed their ability to administer successful CPT programming and researchers identified the need for more harmonious collaboration regarding low-dose aspirin guidelines.

Similarly observing cardiovascular health in older adults with diabetes, researchers also explored FDA and ADA guidelines on low-dose aspirin (LDA) in patients with and without a history of cardiovascular disease (CVD).

“Despite the 2014 FDA statement that ‘aspirin should not be used to prevent a first heart attack or stroke in patients with no history of CVD,’ more than half of LDA users are older adults who take aspirin for primary prevention. Notably, before the FDA statement, the 2013 ADA had recommended LDA for primary prevention in patients with diabetes who were at an increased risk of cardiovascular disease,” wrote Tran et al.2

Between conflicting FDA and ADA guidelines as well as pharmacists’ role in lowering patient blood pressure, researchers addressed aspirin guideline discrepancies and the barriers and facilitators of implementing CPT.

LDA Recommendations for Older Adults with Diabetes

Using data from the National Health and Nutrition Examination Survey (NHANES), researchers examined the odds of older diabetes patients (over 59 years old) without a history of CVD being recommended LDA.

Researchers addressed patient outcomes for improving cardiovascular health. | image credit: BillionPhotos.com / stock.adobe.com

Researchers addressed patient outcomes for improving cardiovascular health. | image credit: BillionPhotos.com / stock.adobe.com

Of 2001 participants (mean age 70 years; 53% men; 74.6% without history of CVD), 68.3% of patients without a history of CVD were recommended LDA.2

Furthermore, patients with no history of CVD were not associated with lower odds of receiving LDA recommendations. Instead, high cholesterol correlated with a higher chance of LDA recommendation.2

“With a high prevalence of LDA recommendation for primary prevention, albeit with limited benefits, our study highlights an urgent need for effective strategies to improve guideline implementation. It is important to raise awareness and resolve conflicting clinical recommendations, exemplified by the varying statements from the FDA, U.S. Preventive Services Task Force, and ADA on LDA recommendation for primary prevention,” continued Tran et al.

Stating that the 2014 FDA statement did not affect LDA recommendations2, researchers called for more diligence across all sectors to ensure the most up-to-date and effective guidelines for patients with and without a history of CVD.

Pharmacists’ Role in Implementing CPT Programs

“The pharmacists participating in the CPT program helped lower patients' blood pressure. The practice changes guided by the program supported the pharmacists in monitoring blood pressure longitudinally. Key facilitators were providing information for practice transformation through change packages and peer coaching,” wrote the authors.1

Results of the second poster presented at the American Pharmacists Association Annual Meeting were successful across the board regarding pharmacists’ ability to lower blood pressure in patients diagnosed with hypertension.

Indeed, within the CPT program, mean systolic blood pressure was lowered from 144.2 to 133.6. Mean diastolic blood pressure was lowered from 84.4 to 78.3.1

At the end of the program, pharmacists were given a survey to assess key facilitators and barriers to executing the main functions of CPT.

“The most common facilitators of the CPT program were CPT change packages and CPT coaching at 87%,” wrote the authors.1 “The most common obstacle was service documentation (73.9%).”

From pharmacists’ expanding scope of practice to reassessing commonly referenced health guidelines, researchers are addressing cardiovascular health to “ultimately improve patient’s clinical outcomes and safety,” concluded the authors.2

Read more of our coverage from the 2024 APhA Annual Meeting and Exposition.

References
1. Alhersh E, Doucette W, Ludwig L, et al. Effect of a community pharmacy cardiovascular practice transformation (CPT) program on blood pressure. Presented at: American Pharmacists Association Annual Meeting and Exposition; March 22-25; Orlando, FL. Poster 1019.
2. Tran N, Coe A, Lester C. Effect of the FDA statement on low-dose aspirin recommendation for primary prevention of cardiovascular disease among older adults with diabetes: a population-based analysis of NHANES 2011-2018. Presented at: American Pharmacists Association Annual Meeting and Exposition; March 22-25; Orlando, FL. Poster 1020.
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