title: Pharmacist-involved care for patients with heart failure and acute coronary syndrome: a systematic review with qualitative and quantitative meta-analysis.
abstract: OBJECTIVE
  Many trials have indicated that interventions by pharmacists resulted in beneficial outcomes with positive effects on cardiovascular diseases. The interventions through pharmacist-involved pharmaceutical care in patients with heart failure (HF) and acute coronary syndrome (ACS) were reviewed systemically and examined.
  
  
  METHODS
  A systematic literature search was conducted to identify relevant articles describing pharmacist interventions in HF and ACS. Most studies were evaluated qualitatively, and the strength of evidence was graded according to the Agency for Healthcare Research and Quality (AHRQ) guidelines. Some of the studies were also assessed by a meta-analysis.
  
  
  RESULTS
  A total of 26 studies containing data on 9415 patients were identified. For all studies, the strength of the body of evidence was reviewed and graded, and 14 studies among them were meta-analysed. The evidence was not strong enough to determine the effects of pharmaceutical care on major and patient-centred outcomes, except the prescription rates of angiotensin-converting-enzyme inhibitors (ACEI) with a high strength of evidence. In the meta-analysis, all-cause hospitalization [odds ratio (OR), 0·74; 95% confidence interval (CI), 0·58-0·94] was reduced and the prescription rates of angiotensin-converting-enzyme inhibitors (ACEI; OR 1·43; 95% CI, 1·07-1·91) and beta-blockers (OR 1·92; 95% CI, 1·24-2·96) were significantly higher in the pharmaceutical care group compared with the usual care group.
  
  
  CONCLUSIONS
  All-cause hospitalization showed improvement in the pharmaceutical care group. However, the strength of evidence for the majority of outcomes with pharmaceutical care, except direct performance measures such as prescription rates, was either insufficient or low. This could be explained by the presence of imprecision and inconsistency derived from the diversity of pharmaceutical care, the heterogeneity of patient populations or clinical settings. Moreover, it may indicate the necessity for homogeneous applicable criteria for assessment. A standardized consensus of the guidelines for pharmaceutical care service should be considered to improve homogeneity.
authors.affiliation: Division of Life and Pharmaceutical Sciences Graduate School and College of Pharmacy, Ewha Womans University, Seoul, Korea.|Department of Pharmacy, National Medical Center, Seoul, Korea.
authors.forename: J E
authors.initials: JE
authors.lastname: Kang
authors.affiliation: College of Pharmacy, Seoul National University, Seoul, Korea.
authors.forename: N Y
authors.initials: NY
authors.lastname: Han
authors.affiliation: College of Pharmacy, Seoul National University, Seoul, Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Oh
authors.affiliation: Division of Life and Pharmaceutical Sciences Graduate School and College of Pharmacy, Ewha Womans University, Seoul, Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Jin
authors.affiliation: Division of Life and Pharmaceutical Sciences Graduate School and College of Pharmacy, Ewha Womans University, Seoul, Korea.
authors.forename: H A
authors.initials: HA
authors.lastname: Kim
authors.affiliation: Department of Pharmacy, National Medical Center, Seoul, Korea.
authors.forename: I J
authors.initials: IJ
authors.lastname: Son
authors.affiliation: Division of Life and Pharmaceutical Sciences Graduate School and College of Pharmacy, Ewha Womans University, Seoul, Korea.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhie
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D010593:Pharmaceutical Services; D010595:Pharmacists
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: acute coronary syndrome; heart failure; pharmaceutical care; pharmacist