Pharmacy based interventions for cardiovascular patients
Abstract
One of the major causes for hospitalization all around the world has been found to be the heart related diseases. These also contribute to a major demise rate of individuals of all populations across the globe. The various controllable and uncontrollable factors contributing towards cardiovascular malfunction and disease include hypertension / high blood pressure, diabetes mellitus, hypercholesterolemia / hyperlipidemia, sedentary lifestyles, bad eating habits, being overweight, genetics, gender, age and ethnicity. Of these, high blood pressure is of considerable importance as it leads to various heart and its vessels associated anomalies such as blockage of arteries and veins, increased pressure and thus workload of heart and damage of heart veins and arteries, to name but a few of them. Therefore, the current pharmaceutical intervention is designed in view of the heart diseases risks which arise as a result of the hypertension. The plan of this intervention is to target the hospital based clinical patients having a history of high blood pressure and medication. The proposal also makes sure to take care of the randomization of the intervention as well as statistical parameters. Moreover, not only the data from hospital repositories is aimed to be utilized but also the record keeping and follow-up for future heart disease development with this pharmaceutical intervention ensures a better outreach but also an improved analysis of the plan. By getting positive outcomes form this study, not only it will help reduce the cardiovascular health risk of hypertension locally but also with increasing data support it will help target the global population as well thus contributing towards the sustainable development goals of the world as a whole.
Introduction
Cardiovascular disease
In general terms, cardiovascular diseases are also known under the name of heart diseases whereby heart and its associated blood vessels are affected resulting in various malfunctions of the heart. These anomalies lead to various types of heart diseases, the most common of which are: heart attack, stroke, heart failure, various arrhythmias, heart valve problems, cerebrovascular, rheumatic and congenital heart diseases (World Health Organization, 17 May 2017).
Prevalence of cardiovascular disease
According to a study by Global Burden of Disease (GBD) conducted in 2015, 422.7 million of cardiovascular disease cases were estimated around the world and 17.92 million deaths were attributed to this group of diseases. Of these cardiovascular diseases, ischemic heart disease was the major cause of health loss globally (Roth et al., 2017). This way, cardiovascular disease poses a major risk as well as barrier towards the human sustainable development goals around the world. It has also been recognized formally as a non-communicable disease by World Health Organization thereby not only increasing concerns for global health but also for ambitious interventions to reduce its effect in all regions of the world (Alwan, 2011). Moreover, the importance of cardiovascular diseases has also been recognized by the third sustainable development goal which aims to achieve a reduction in premature mortality by one third by targeting CVDs alone (Department of Economic and Social Affairs).
Focusing on the affliction of cardiovascular diseases in Australian people, these lead to one death every 4-5 individuals having a death rate of one person in 19 minutes, with coronary heart disease being the leading cause of demise among them. Moreover, the per day rate of hospitalization of heart patients od 1100 people of those men are 46% more in number than females. In percentages, cardiovascular disease is present in 16.6% population of Australia, with the prevalence of heart failure, coronary heart disease and heart attach being 0.5%, 2.4%, and 1.6%, respectively. The key risk factors contributing to these are the high blood pressure and cholesterol levels which come under the preventable factors of the disease. However, the sad thing is the unawareness of people in not associating these risk factors as a cause of decline in their heart health and function (Heart Foundation).
Coronary heart disease (CHD) represents the leading cause of heart patients’ deaths in Australia with 2.4% Australian population living with CHD. It is found to be more common in men than women, with 3.2% of former and 1.7% of latter living with CHD. The stats for CHD are such that it represents 1 out of every 10 deaths, killing one person every 30 minutes and overall rate of 48 deaths and 443 hospitalizations per day (Heart Foundation).
Burden of cardiovascular diseases and associated costs
In 2015, Australian Burden of Disease Study did an analysis to find the burden of different disease, risk factors, injuries and disease conditions in Australian population so as to assess, quantify and classify these diseases according to their fatal or non-fatal nature. When investigated with respect to the cardiovascular disease, it came out to be accounting for almost 14% of total disease burden as per 2015 analysis report. However, the value of this burden was less than the estimates done in 2003 and 2001 studies by approximately 18% and 15%, respectively. Again, coronary heart disease contributed most to this burden, accounting for about 7% of heart disease in 2015 (Australian Institute of Health and Welfare).
Of the total health expenditure in Australia, the largest was found to be in hospitals totaling to about $70.7 billion, followed by non-hospital medical, pharmaceuticals and dental expenditures of $22.5, $13.9 and $9.9 billion, respectively. Moreover, the total expenditure as well per person cost was also seen to be showing a general increase with respect to increasing age in the Australian population. Considering the expenditure on cardiovascular disease, an estimate of 8.9% was attributed to the cardiovascular diseases in 2015-2016 from total disease expenditure, equaling to about $10.4 billion. In addition, cardiovascular group constitutes the most expensive disease group of patients in admitted in public hospitals (Australian Institute of Health and Welfare).
High blood pressure – a risk factor for developing heart diseases
The various risk factors which can ultimately lead to the development of heart diseases are: smoking, high cholesterol and lipids in the body, high blood pressure, a sedentary lifestyle, uncontrolled diabetes, being overweight and unhealthy eating and diet habits. In Australia, about 90% people have one or more risk of developing cardiovascular diseases with its prevalence increasing in people with increasing number of risk factors. Apart from these controllable risk factors, other risk factors are age, gender, ethnicity and genetics which are not under one’s control. Often termed as the ‘silent killer’, high blood pressure does not present itself with loud symptoms but is a major risk factor for development of heart diseases. This can be primarily attributed to the facts that it leads to: damaging of arteries; blockage and prevention of blood flow to heart; clogging of brain blood vessels; and enlargement of heart due to increased workload (Heart; Heart Research Australia).
Method
A great potential for various health promotions and interventions as well as disease prevention lies in the hands of community pharmacies / pharmacists located under the auspices of hospitals and their clinics. Thus the aim and design of our current intervention is to minimize or prevent the risk of cardiovascular disease via community based pharmacists’ blood pressure control interventions (Duedahl, Hansen, Kjeldsen, & Graabæk, 2018; Flanagan & Barns, 2018).
Design of study
This intervention study will entail the pharmacists’ intervention in a randomized control clinical trial (RCT) for BP control in patients. The participants will be randomly allocated to two parallel groups with eligibility criteria being adults aging 18 or more and having a recognized medical diagnosis of hypertension of arterial blood accompanied with information about controlled or uncontrolled blood pressure. Moreover, all the participant patients must be on antihypertensive drug treatment during the past 2 years. Individuals who are breastfeeding, pregnant or have dementia will be excluded from this study (Patel et al., 2016; Xu et al., 2019).
The study design will be started with the proper consent taking from patients according to informed consent Australian law followed by the ethics of privacy maintenance(Australian Government – Australian Law Reform Commission; Salari et al., 2013). Outpatients who will be following their routine follow-up examinations at hospital clinics will be divided into two groups – a control group and an intervention group. The control group will be comprising outpatients who will receive their general scheduled care and no pharmacy intervention. On the other hand, pharmaceutical care intervention group will be of those patients who will have a follow-up by a pharmacist quarterly during a period of 3-5 years. Clinical data for this study will include measurements of blood pressure, record keeping of prescribed medicines along with the medical complications. To aid in data collection, collaboration with hospital management authorities can be done to facilitate this process via access to the electronic records databases. Moreover, the maintenance of BP will be evaluated in compliance with the statistical significance tests. Finally, the results gained will be used for the assessment of cardiovascular disease risk over time specified (Cheema, Sutcliffe, & Singer, 2014; Santschi et al., 2014; Santschi, Chiolero, Paradis, Colosimo, & Burnand, 2012; Tan, Stewart, Elliott, & George, 2014).
Comparisons with similar interventions
A similar randomized trial was carried out for enhancement of hypertension control via pharmacy intervention platform, the main focus area of which was Portugal (Morgado, Rolo, & Castelo-Branco, 2011). In another study, it was demonstrated that a collaborative effort of medical teams with pharmacists helped in the control of blood pressure (Gums et al., 2015). Similarly, another group of researcher studied the effect of pharmacist intervention with respect to contribution in preventing heart failure in elderly individuals having high risk and found a significant decrease in the cholesterol and triglyceride levels in patients (Lee et al., 2015).
Conclusion
The systematic studies of pharmaceutical interventions to prevent heart diseases indicate that a mutual involvement and working of both the medical staff and pharmacists is not only helpful in enhancing the risk prevention of heart diseases but also leads to an ultimate positive effects on the public health outcomes. Moreover, the outreach and services of pharmacy interventions lead to improved management of disease symptoms as well as compliance to respective medications.
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Key reference
A systematic review of community pharmacists’ intervention in reducing major risk factors for cardiovascular disease (Ifeanyi Chiazor, Evans, van Woerden, & Oparah, 2015).
