title: Impact of a pharmacist-delivered discharge and follow-up intervention for patients with acute coronary syndromes in Qatar: a study protocol for a randomised controlled trial.
abstract: Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality worldwide. Secondary cardiovascular risk reduction therapy (consisting of an aspirin, a β-blocker, an ACE inhibitor or an angiotensin II receptor blocker and a statin) is needed for all patients with ACS. Less than 80% of patients with ACS in Qatar use this combination after discharge. This study is aimed to evaluate the effectiveness of clinical pharmacist-delivered intervention at discharge and tailored follow-up postdischarge on decreasing hospital readmissions, emergency department (ED) visits and mortality among patients with ACS.
  
  
  
  A prospective, randomised controlled trial will be conducted at the Heart Hospital in Qatar. Patients are eligible for enrolment if they are at least 18 years of age and are discharged from any non-surgical cardiology service with ACS. Participants will be randomised into 1 of 3 arms: (1) 'control' arm which includes patients discharged during weekends or after hours; (2) 'clinical pharmacist delivered usual care at discharge' arm which includes patients receiving the usual care at discharge by clinical pharmacists; and (3) 'clinical pharmacist-delivered structured intervention at discharge and tailored follow-up postdischarge' arm which includes patients receiving intensive structured discharge interventions in addition to 2 follow-up sessions by intervention clinical pharmacists. Outcomes will be measured by blinded research assistants at 3, 6 and 12 months after discharge and will include: all-cause hospitalisations and cardiac-related hospital readmissions (primary outcome), all-cause mortality including cardiac-related mortality, ED visits including cardiac-related ED visits, adherence to medications and treatment burden. Percentage of readmissions between the 3 arms will be compared on intent-to-treat basis using χ2test with Bonferroni's adjusted pairwise comparisons if needed.
  
  
  
  The study was ethically approved by the Qatar University and the Hamad Medical Corporation Institutional Review Boards. The results shall be disseminated in international conferences and peer-reviewed publications.
  
  
  
  NCT02648243; pre-results.
authors.affiliation: Clinical Pharmacy and Practice Section, Qatar University College of Pharmacy, Doha, Qatar.
authors.forename: Amani
authors.initials: A
authors.lastname: Zidan
authors.affiliation: Clinical Pharmacy and Practice Section, Qatar University College of Pharmacy, Doha, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Awaisu
authors.affiliation: Clinical Pharmacy and Practice Section, Qatar University College of Pharmacy, Doha, Qatar.
authors.forename: Nadir
authors.initials: N
authors.lastname: Kheir
authors.affiliation: Weill Cornell Medicine-Qatar, Doha, Qatar.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Mahfoud
authors.affiliation: Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rasha
authors.initials: R
authors.lastname: Kaddoura
authors.affiliation: Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Sumaya
authors.initials: S
authors.lastname: AlYafei
authors.affiliation: Clinical Pharmacy and Practice Section, Qatar University College of Pharmacy, Doha, Qatar.
authors.forename: Maguy Saffouh
authors.identifier: 0000-0003-0770-4679
authors.initials: MS
authors.lastname: El Hajj
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010595:Pharmacists; D011446:Prospective Studies; D011780:Qatar; D012107:Research Design; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute Coronary Syndrome; Discharge; Intervention; Pharmacist; Qatar