A community pharmacy-based cardiovascular risk screening service implemented in Iran
Background: Cardiovascular disease is a major health concern around the world.
Objective: To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran.
Methods: A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded.
Results: Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician.
Conclusion: A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required.
2. Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, Ghanbili J, Ghanbarian A, Mehrabi Y, Saadat N, Salehi P, Mortazavi N, Heydarian P, Sarbazi N, Allahverdian S, Saadati N, Ainy E, Moeini S. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed. 2002;47(6):408-426.
3. Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M, Khalili A, Mostafavi S, Khami M, Hassanvand R. Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol. 1999;54(6):327-333.
4. O'Donovan DO, Byrne S, Sahm LJ. Pharmacist’s Use of Screening Tools to Estimate Risk of CVD: A Review of the Literature. Pharmacy. 2014;2(1):27-39. doi: 10.3390/pharmacy2010027
5. Ebrahimi M, Kazemi-Bajestani SM, Ghayour-Mobarhan M, Ferns GA. Coronary artery disease and its risk factors status in iran: a review. Iran Red Crescent Med J. 2011;13(9):610-623.
6. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952. doi: 10.1016/S0140-6736(04)17018-9
7. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med. 1993;119(12):1187-1197.
8. Carter M, Karwalajtys T, Chambers L, Kaczorowski J, Dolovich L, Gierman T, Cross D, Laryea S; CHAP Working Group. Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities. Health Promot Int. 2009;24(4):325-333. doi: 10.1093/heapro/dap030
9. Taylor R, Dobson A, Mirzaei M. Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades. Eur J Cardiovasc Prev Rehabil. 2006;13(5):760-768. doi: 10.1097/01.hjr.0000220581.42387.d4
10. George PP, Molina JA, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management - a literature review. Ann Acad Med Singapore. 2010;39(11):861-867.
11. Bovet P, Hirsiger P, Emery F, De Bernardini J, Rossier C, Trebeljahr J, Hagon-Traub I. Impact and cost of a 2-week community-based screening and awareness program for diabetes and cardiovascular risk factors in a Swiss canton. Diabetes Metab Syndr Obes. 2011;4:213-223. doi: 10.2147/DMSO.S20649
12. Horgan JM, Blenkinsopp A, McManus RJ. Evaluation of a cardiovascular disease opportunistic risk assessment pilot ('Heart MOT' service) in community pharmacies. J Public Health (Oxf). 2010;32(1):110-116. doi: 10.1093/pubmed/fdp092
13. Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: Systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770-1781. doi: 10.1345/aph.1K311
14. Tsuyuki RT, Johnson JA, Teo KK, Ackman ML, Biggs RS, Cave A, Chang WC, Dzavik V, Farris KB, Galvin D, Semchuk W, Simpson SH, Taylor JG. Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): a randomized trial design of the effect of a community pharmacist intervention program on serum cholesterol risk. Ann Pharmacother. 1999;33(9):910-919. doi: 10.1345/aph.18380
15. Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25(2):144-153.
16. Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev. 2004;(1):CD003698. doi: 10.1002/14651858.CD003698.pub2
17. George J, McNamara K, Stewart K. The roles of community pharmacists in cardiovascular disease prevention and management. Australas Med J. 2011;4(5):266-272. doi: 10.4066/AMJ.2011.698
18. Mangum SA, Kraenow KR, Narducci WA. Identifying at-risk patients through community pharmacy-based hypertension and stroke prevention screening projects. J Am Pharm Assoc (Wash). 2003;43(1):50-55. doi: 10.1331/10865800360467042
19. Dimeski G, Jones BW, Tilley V, Greenslade MN, Russell AW. Glucose meters: evaluation of the new formulation measuring strips from Roche (Accu-Chek) and Abbott (MediSense). Ann Clin Biochem. 2010;47(Pt 4):358-365. doi: 10.1258/acb.2010.009291
20. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-753. doi: 10.1161/CIRCULATIONAHA.107.699579
21. Donyai P, Van den Berg M. Coronary heart disease risk screening: the community pharmacy healthy heart assessment service. Pharm World Sci. 2009;31(6):643-647. doi: 10.1007/s11096-009-9338-4
22. Hunt BD, Hiles SL, Chauhan A, Ighofose C, Bharakhada N, Jain A, Davies MJ, Khunti K. of the Healthy LifeCheck programme: a vascular risk assessment service for community pharmacies in Leicester city, UK. J Public Health (Oxf). 2013;35(3):440-446. doi: 10.1093/pubmed/fdt017
23. Azizi F, Raiszadeh F, Salehi P, Rahmani M, Emami H, Ghanbarian A, Hajipour R. Determinants of serum HDL-C level in a Tehran urban population: the Tehran Lipid and Glucose Study. Nutr Metab Cardiovasc Dis. 2002;12(2):80-89.
24. Hosseini M, Navidi I, Yousefifard M, Heshmat R, Koohpayehzadeh J, Asgari F, Etemad K, Rafei A, Gouya MM. Serum HDL-C level of Iranian adults: results from sixth national surveillance of risk factors of non-communicable disease. J Diabetes Metab Disord. 2014;13:67. doi: 10.1186/2251-6581-13-67
25. Ahmadzadeh A, Azizi F. Genes associated with low serum high-density lipoprotein cholesterol. Arch Iran Med. 2014;17(6):444-450. doi: 014176/AIM.0013
26. Zillich AJ, Sutherland JM, Kumbera PA, Carter BL. Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med. 2005;20(12):1091-1096. doi: 10.1111/j.1525-1497.2005.0226.x
27. McKenney J. Pharmacy management of hypertensive patients. J Am Pharm Assoc. 1974;14(4):190-195.
28. McKenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48(5):1104-1111.
29. Park JJ, Kelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc (Wash). 1996;NS36(7):443-451.
30. Carter BL, Barnette DJ, Chrischilles E, Mazzotti GJ, Asali ZJ. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy. 1997;17(6):1274-1285.
31. Haghdoost AA, Sadeghirad B, Rezazadehkermani M. Epidemiology and heterogeneity of hypertension in Iran: a systematic review. Arch Iran Med. 2008;11(4):444-452. doi: 08114/AIM.0017
32. Khosravi A, Mehr GK, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, Noori F, Sarrafzadegan N. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program. BMC Cardiovasc Disord. 2010;10:61. doi: 10.1186/1471-2261-10-61
33. Noohi F, Sarrafzadegan N, Khosravi A, Andalib E; First Recommendation on High Blood Pressure Working Group. The first Iranian recommendations on prevention, evaluation and management of high blood pressure. ARYA Atheroscler. 2012;8(3):97-118.
34. Larijani B, Zahedi F. Epidemiology of diabetes mellitus in Iran. Iran J Diabet Metab Disord. 2002;1(1):7.
35. Edelman D, Edwards LJ, Olsen MK, Dudley TK, Harris AC, Blackwell DK, Oddone EZ. Screening for diabetes in an outpatient clinic population. J Gen Intern Med. 2002;17(1):23-28.
36. Snella KA, Canales AE, Irons BK, Sleeper-Irons RB, Villarreal MC, Levi-Derrick VE, Greene RS, Jolly JL, Nelson AA. Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals. J Am Pharm Assoc (2003). 2006;46(3):370-377.
37. Wilkins D, Payne S, Granville G, Branney P. The gender and access to health services study: final report. 2008. Availabel at: http://www.sfh-tr.nhs.uk/attachments/article/41/The%20gender%20and%20access%20to%20health%20services%20study.pdf (accessed 11-Apr-2017).
38. Tonsad S, Sandvik E, Lund Larsen PG, Thelle D. Gender Differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease. Metab Syndr Relat Disord. 2007;5(2):174-182. doi: 10.1089/met.2006.0037
39. Krieger J, Collier C, Song L, Martin D. Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers. Am J Public Health. 1999;89(6):856-861.
40. Via-Sosa MA, Toro C, Trave P, March MA. Screening premorbid metabolic syndrome in community pharmacies: a cross-sectional descriptive study. BMC Public Health. 2014;14:487. doi: 10.1186/1471-2458-14-487
41. Jahangard-Rafsanjani Z, Sarayani A, Javadi M, Hadjibabaie M, Rashidian A, Ahmadvand A, Gholami K. Pharmacists’ Attitudes and Perceived Barriers about Community Pharmacy-Based Cardiovascular Risk Screening Services. J Pharm Care. 2014;2(4):142-148.
42. Azami Aghdash S, Ghojazadeh M, Shams-Vahdati S, Piri R, Klvany Kh, Yaghoubi R, Asli Z, Naghavi-Behzad M. Barriers and strategies for identifying and managing risk factors of cardiovascular diseases in levels of preventing, screening, and treating. J Anal Res Clin Med. 2015;3(4):197-205. doi: 10.15171/jarcm.2015.032
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.