Development of a pharmacist-led cholesterol screening and lipid-lowering medication review service in coronary artery bypass graft patients

Abstract

AbstractObjectiveTo assess the effects of pharmacist intervention on lipid management in coronary artery bypass graft (CABG) patients.MethodOpen study in which total cholesterol (TC) levels were measured in 43 elective CABG patients at visit 1 (pre-surgery) and visit 2 (six weeks post-discharge following surgery). Statin therapy was initiated (using atorvastatin) or statin doses were adjusted according to an agreed protocol.Key findingsPrior to CABG surgery, 19 patients (44 per cent) did not have target TC values. Fourteen (74 per cent) of these patients were already receiving a statin while five patients (26 per cent) were not receiving statin therapy. At visit 2, 33 patients (77 per cent) had achieved target TC. Mean (SD) TC was 5.7 (0.72) mmol/L at visit 1 and 4.8 (0.68) mmol/L at visit 2 in the intervention patients (P<0.01). There was no significant difference between mean TC at visits 1 and 2 in the non-intervention patients (patients who had target TC values at visit 1). From a previous meta-analysis, the decrease in TC of 0.9 mmol/L (16 per cent) in the intervention patients equates to a 24 per cent risk reduction in coronary heart disease (CHD) mortality and an 18 per cent risk reduction in total mortality. The recent National Service Framework for CHD has set standards for improving the care of CHD patients. From this study, it appears that the management of raised TC in this high-risk population is sub-optimal.ConclusionThis study has shown that the role of the pharmacist can be extended to encompass the management of raised total cholesterol in CABG patients, thereby contributing towards health care benefit.