Summary of principal systematic reviews or meta-analyses assessing the impact of the pharmacist’s intervention on cardiovascular risk factors and diseases
| Authors (year) (ref.) | No. and type of studies included | No. and type of subjects | Pharmacy setting | Type of pharmacist’s intervention | Length of follow-up | Effect of the intervention |
| Concomitant risk factors for coronary disease | ||||||
| Blenkinsopp et al (2003)9 | 9 (4 RCTs and 5 non-RCTs) | 4091 smokers or subjects at high risk for coronary heart disease | Community | Patient advice in smoking cessation and lipid management | Range: 2 weeks– 12 months | A positive effect in the reduction of risk behaviours and control of risk factors for coronary heart disease was observed in RCTs, but not in observational studies |
| Santschi et al (2011)10 | 30 RCTs | 11 765 patients with various cardiovascular risk factors (mainly hypertension, dyslipidaemia, diabetes or smoking) | Outpatient clinic Community | Patient educational interventions, patient-reminder systems, measurement of cardiovascular risk factors, medication management and feedback to physician, educational intervention to healthcare professionals | Range: 3–24 months Mean: 8.0 months | Pharmacist care was associated with significant reduction in blood pressure and serum cholesterol and a reduction in the risk of smoking |
| Tan et al (2014)5 | 17 RCTs | Patients with cardiovascular disease, diabetes, hypertension or dyslipidaemia (overall number not reported) | Outpatient clinic | Mainly medication review with or without collaborative activities delivered with the general practitioner | Not reported | Significant improvements in blood pressure, haemoglobin A1C, serum cholesterol and Framingham risk score in the intervention compared with control patients were observed |
| Brown et al (2016)11 | 24 (19 RCTs and 5 non-RCTs) | 14 546 smokers or subjects with comorbidities (diabetes, dyslipidaemia or hypertension) | Community | Behavioural support and multicomponent intervention (pharmacotherapy and lifestyle changes) | Range: 5–56 weeks | Pharmacy-based intervention were effective and cost-effective for smoking cessation, but not for weight loss or managing alcohol misuse. They were also effective to improve measures associated with the comorbidities |
| Hypertension | ||||||
| Machado et al (2007)13 | 13 RCTs | 2246 hypertensive patients | Hospital Outpatient clinic Community | Medication management and education about high blood pressure | Mean: 7.6 months | Enhanced systolic blood pressure control and no improvement in adherence to antihypertensive treatment was observed |
| Morgado et al (2011)14 | 8 RCTs | 2619 hypertensive patients | Hospital Outpatient clinic Community | Medication management, educational interventions, blood pressure measurement, medication reminders, improved administration systems, personal contacts | Range: 2 weeks–12 months Mean: 6.7 months | Blood pressure control improved in the whole group and medication adherence increased in responding patients |
| Santschi et al (2014)15 | 39 RCTs | 14 224 patients with any modifiable cardiovascular risk factors | Outpatient clinic Community | Patient education and counselling about lifestyle, medication and medication adherence, blood pressure measurement, medication management, reminder system and healthcare professional training | Range: 3–13 months Mean: 6 months Median: 8.3 months | Larger blood pressure reductions were observed following pharmacist’s intervention, particularly if this was led directly by the pharmacist, without co-management, and done at least monthly |
| Cheema et al (2014)16 | 16 RCTs | 3032 hypertensive patients with comorbidities | Community | Patient education on hypertension, management of prescribing and safety problems associated with medication, and advice on lifestyle | Range: 3–13 months | Pharmacist-led intervention was associated with significant reductions in blood pressure and improvement in adherence |
| Fleming et al (2015)17 | 14 non-RCTs | 8,462,281 patients with hypertension | Community | Blood pressure measurement by the pharmacist, assistant or patient’s self-measurement. | Not applicable | Community pharmacist screening of raised blood pressure helped in identification of new cases of hypertension |
| Dyslipidaemia | ||||||
| Machado et al (2008)18 | 23 (6 RCTs and 17 non-RCTs) | 2343 patients with dyslipidaemia | Hospital Outpatient clinic Community | Patient education and medication management | Mean: 9.9 months | Pharmacist intervention improved total cholesterol, whereas the impact on patient’s adherence to treatment regimen and quality of life were not homogeneously affected |
| Charrois et al (2012)19 | 21 RCTs | 5416 patients with dyslipidaemia | Outpatient clinic Community | Medication dispensing, adherence, patient education | Range: 16 weeks – 2 years Median: 12 months | Pharmacist care improved lipid parameters in patients with dyslipidaemia |
| Diabetes | ||||||
| Wubben et al (2008)20 | 21 (9 RCTs and 12 non-RCTs) | 3981 diabetics | Outpatient clinic Community | Drug dispensing and management, education on lifestyle, diabetes self-care (review of home glucose monitoring records), drug prescription under the physician’s supervision | Range: 3–24 months | Improvement in haemoglobin A1c after pharmacist’s care and potential for reduced long-term costs by improving glycaemic control was documented |
| Machado et al (2007)21 | 30 (18 RCTs and 12 non-RCTs) | 2247 diabetics | Hospital Outpatient clinic Community | Diabetes education and medication management | Mean: 11.3 months | Pharmacist intervention was associated with a significant reduction in haemoglobin A1c |
| Evans et al (2011)22 | 40 (11 RCTs and 29 non-RCTs) | 11 871 diabetics | Community | Patient-directed activities (follow-up, education, reminders) and/or physician directed activities (follow-up medication management, laboratory test ordering) | Range: 2–57 months | No specific study intervention emerged as superior and particularly effective in managing the patients |
| Coronary heart disease | ||||||
| Cai et al (2013)23 | 5 RCTs | 2568 patients with coronary artery disease | Hospital Outpatient clinic Community | Patient education, medication management, feedback to healthcare professionals, disease management | Range: 6 months– 2 years | No significant effect on mortality, recurrent cardiac events or hospitalisation of coronary heart disease was shown, but significant positive effect on medication adherence in the majority of studies |
| Altowaijri et al (2013)24 | 59 (45 RCTs, 6 non- RCTs, 8 economic studies) | Patients with an established cardiovascular disease (coronary heart disease or heart failure) or with cardiovascular risk factors (diabetes mellitus, hypertension, hyperlipidaemia, smoking) (overall number not reported) | Hospital Outpatient clinic Community | Educational intervention, medicine management intervention or both | Not reported | In the majority of the studies the pharmacist intervention was associated with better improvement in patients’ outcomes (morbidity or mortality, risk factor control, patient’s knowledge, adherence and quality of life) and reduced healthcare costs |
| Heart failure | ||||||
| Ponniah et al (2007)26 | 7 (5 RCTs and 2 non-RCTs) | Patients with heart failure after discharge (overall number not reported) | Hospital Outpatient clinic Community | Home-based intervention or medication review service | Not reported | In most studies, the pharmacist’s intervention reduced postdischarge morbidity and mortality and increased compliance and medication knowledge |
| Koshman et al (2008)27 | 12 RCTs | 2060 in- and out-patients with heart failure | Hospital Outpatient clinic Community | Patient education on the disease and on the medication, including self-monitoring, medication management, and facilitation of compliance | Range: 6–12 months | Pharmacist care reduced the risk of all-cause and heart failure hospitalisations |
| Davis et al (2014)28 | 25 (9 RCTs and 16 non-RCTs) | 2 44 597 patients with heart failure | Hospital Outpatient clinic Community | Patient education | Range: 3 months– 5 years | Improvement in medication adherence was observed, but this dissipated once the intervention was withdrawn |
| Thomas et al (2014)29 | 4 RCTs | 466 older people with heart failure | Hospital Community | In-hospital and community pharmacist’s education and counselling to patients regarding, medication, adherence and disease knowledge. Interaction with the physician for medication dispensing and recommendations in case of hospital pharmacist | Range: 6–12 months | Interventions delivered by a hospital, but not that by a community pharmacist, reduced the risk of hospital admissions |
| Cheng et al (2014)30 | 13 (10 RCTs and 3 non-RCTs) | 4080 patients with heart failure | Hospital Outpatient clinic Community | Medication reconciliation, patient education, collaborative medication management | Not reported | Pharmacist’s care was associated with significant positive change in the therapeutic outcomes, decrease hospitalisations and readmissions, improvement in overall patient self-perception |
| Kang et al (2016)31 | 14 RCTs | 4508 patients with coronary heart disease or heart failure | Hospital Outpatient clinic Community | Educational interventions directed to the patients, adherence assessment, home visits, counselling interventions | Range: 1–24 months | Significant improvement in all-cause hospitalisation and in prescription rates for the secondary cardiovascular prevention, but not in all-cause mortality and cardiac-related hospitalisation |
RCT, randomised controlled trial.