Effect of a Clinical Pharmacy Service on Lipid Control in Patients with Peripheral Arterial Disease

Thomas F. Rehring, MD, University of Colorado Health Sciences Center, Department of Vascular Surgery, Colorado Permanente Medical Group, Denver, CO;

Purpose: Our group and others have previously established that patients with peripheral artery disease (PAD) are significantly undertreated with respect to overall cardiovascular risk factor management despite national guidelines to the contrary. In an effort to maximize risk factor control in our patients with PAD, we established a pharmacist-managed, physician-monitored algorithmic approach to the outpatient management of lipids in patients with PAD. The purpose of this study was to determine the effect of this service on lipid screening and control in patients with PAD.
Methods: We analyzed the records of patients treated at a regional health maintenance organization serving approximately 400,000 members. An electronic medical record provided full examination, laboratory, and pharmacy data for all patients. Pharmacy data was analyzed to determine prescriptions for lipid lowering agents. Lipid control was assessed through fasting lipid data. Patients with validated PAD and the absence of clinical coronary artery disease (CAD) were offered the service between May 2003 and September 2004 and followed for a minimum of 6 months.
Results: We administratively identified 5159 active patients with a diagnosis of PAD. Of these, 1075 could be validated with a noninvasive arterial study. The exclusion of 384 patients with a diagnosis of CAD resulted in a cohort of 691 patients. Of these, 90 randomly selected patients were enrolled in the lipid service (study group) and 601 received standard care. Mean follow-up was 15.2 months. Screening fasting lipid profiles were found in 95.6% (86/90) of patients in the study group and only 66.9% (402/601) of the standard care patients (P <. 001). LDL control was improved in the pharmacist-managed group with 79.1% (68/86) achieving an LDL of < 100 mg/dL in comparison to the standard care group (54.7%, 220/402, P < .001). An LDL value of over 130 mg/dL was noted in 1.2% and 13.9% (56/402) in the treatment and control groups respectively (P = .002). Statin usage was present in 51.9% (312/601) of the control group patients and 84.4% (76/90) of the pharmacist-managed group (P < .001).
Conclusions: Despite national consensus of PAD as a CAD equivalent, patients are currently undertreated with regard to atherosclerotic risk factor modification. Initiation of a pharmacist-managed, physician-monitored lipid service provides improved compliance with national guidelines.