Table 1

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 includedNo. and type of subjectsPharmacy settingType of pharmacist’s interventionLength of follow-upEffect 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 diseaseCommunityPatient advice in smoking cessation and lipid managementRange: 2 weeks– 12 monthsA 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 RCTs11 765 patients with various cardiovascular risk factors (mainly hypertension, dyslipidaemia, diabetes or smoking)Outpatient clinic
Patient educational interventions, patient-reminder systems, measurement of cardiovascular risk factors, medication management and feedback to physician, educational intervention to healthcare professionalsRange: 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 RCTsPatients with cardiovascular disease, diabetes, hypertension or dyslipidaemia (overall number not reported)Outpatient clinicMainly medication review with or without collaborative activities delivered with the general practitionerNot reportedSignificant 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)CommunityBehavioural support and multicomponent intervention (pharmacotherapy and lifestyle changes)Range: 5–56 weeksPharmacy-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
 Machado et al (2007)13 13 RCTs2246 hypertensive patientsHospital
Outpatient clinic
Medication management and education about high blood pressureMean: 7.6 monthsEnhanced systolic blood pressure control and no improvement in adherence to antihypertensive treatment was observed
 Morgado et al (2011)14 8 RCTs2619 hypertensive patientsHospital
Outpatient clinic
Medication management, educational interventions, blood pressure measurement, medication reminders, improved administration systems, personal contactsRange: 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 RCTs14 224 patients with any modifiable cardiovascular risk factorsOutpatient clinic
Patient education and counselling about lifestyle, medication and medication adherence, blood pressure measurement, medication management, reminder system and healthcare professional trainingRange: 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 RCTs3032 hypertensive patients with comorbiditiesCommunityPatient education on hypertension, management of prescribing and safety problems associated with medication, and advice on lifestyleRange: 3–13 monthsPharmacist-led intervention was associated with significant reductions in blood pressure and improvement in adherence
 Fleming et al (2015)17 14 non-RCTs8,462,281 patients with hypertensionCommunityBlood pressure measurement by the pharmacist, assistant or patient’s self-measurement.Not applicableCommunity pharmacist screening of raised blood pressure helped in identification of new cases of hypertension
 Machado et al (2008)18 23 (6 RCTs and 17 non-RCTs)2343 patients with dyslipidaemiaHospital
Outpatient clinic
Patient education and medication managementMean: 9.9 monthsPharmacist 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 RCTs5416 patients with dyslipidaemiaOutpatient clinic
Medication dispensing, adherence, patient educationRange: 16 weeks – 2 years
Median: 12 months
Pharmacist care improved lipid parameters in patients with dyslipidaemia
 Wubben et al (2008)20 21 (9 RCTs and 12 non-RCTs)3981 diabeticsOutpatient clinic
Drug dispensing and management, education on lifestyle, diabetes self-care (review of home glucose monitoring records), drug prescription under the physician’s supervisionRange: 3–24 monthsImprovement 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 diabeticsHospital
Outpatient clinic
Diabetes education and medication managementMean: 11.3 monthsPharmacist intervention was associated with a significant reduction in haemoglobin A1c
 Evans et al (2011)22 40 (11 RCTs and 29 non-RCTs)11 871 diabeticsCommunityPatient-directed activities (follow-up, education, reminders) and/or physician directed activities (follow-up medication management, laboratory test ordering)Range: 2–57 monthsNo specific study intervention emerged as superior and particularly effective in managing the patients
Coronary heart disease
 Cai et al (2013)23 5 RCTs2568 patients with coronary artery diseaseHospital
Outpatient clinic
Patient education, medication management, feedback to healthcare professionals, disease managementRange: 6 months– 2 yearsNo 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
Educational intervention, medicine management intervention or bothNot reportedIn 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
Home-based intervention or medication review serviceNot reportedIn most studies, the pharmacist’s intervention reduced postdischarge morbidity and mortality and increased compliance and medication knowledge
 Koshman et al (2008)27 12 RCTs2060 in- and out-patients with heart failureHospital
Outpatient clinic
Patient education on the disease and on the medication, including self-monitoring, medication management, and facilitation of complianceRange: 6–12 monthsPharmacist 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 failureHospital
Outpatient clinic
Patient educationRange: 3 months– 5 yearsImprovement in medication adherence was observed, but this dissipated once the intervention was withdrawn
 Thomas et al (2014)29 4 RCTs466 older people with heart failureHospital
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 pharmacistRange: 6–12 monthsInterventions 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 failureHospital
Outpatient clinic
Medication reconciliation, patient education, collaborative medication managementNot reportedPharmacist’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 RCTs4508 patients with coronary heart disease or heart failureHospital
Outpatient clinic
Educational interventions directed to the patients, adherence assessment, home visits, counselling interventionsRange: 1–24 monthsSignificant 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.