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Assistant Professor, Department of Pharmacy, David Grant Medical Center, Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Travis Air Force Base, CA
Manager, Center for Drug Information and Outcomes Analysis, Henry Ford Hospital, Detroit, MI
Reprints: Dr. O'Dell, Department of Pharmacy, David Grant Medical Center, Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, 101 Bodin Circle, Travis AFB, CA 94535-1809, fax 707/423-7994, kodell{at}pacific.edu
BACKGROUND: Previous studies have reported a positive impact of pharmacists on care of patients with chronic illnesses. The impact of the clinical pharmacist on hospital readmission in patients with acute coronary syndromes (ACS) has yet to be evaluated, as of this writing.
OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on cardiac-related readmission in patients admitted to the general cardiology unit with ACS.
METHODS: A prospective, nonrandomized observational study compared patients who received standard practice care with patients admitted to a service with a clinical pharmacist to provide care at the bedside. Patients admitted to and discharged from the general cardiology unit for ACS were included. The primary endpoint of the study was cardiac-related readmission at 30 days following hospital discharge. Secondary endpoints included length of stay and medication utilization. Interventions provided by the clinical pharmacist in the study group were documented.
RESULTS: Cardiac readmission at 30 days was similar between the groups (p = 0.59). In the subset of patients with unstable angina, readmission in the study group was significantly lower than in the control group (1.3% vs 9.1%; p = 0.04). Patients in both groups were similarly managed using drug therapy and invasive coronary interventions. The medical staff's rate of acceptance of recommendations provided by the pharmacist was 94.4%. The most common interventions were medication education and identification of indicated therapy.
CONCLUSIONS: The addition of pharmacists did not decrease readmission in patients with ACS. The finding of significant reduction in readmission in the subset of patients with unstable angina should be considered "hypothesis generating" for future randomized studies to confirm the results.
Key Words: acute coronary syndromes, myocardial infarction, unstable angina, pharmacist intervention
Published Online, July 26, 2005. www.theannals.com, DOI 10.1345/aph.1E640
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