title: Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy.
abstract: Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93 % were men, with an average age of 57 years and 15 years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12 months) of the following cardiovascular risk factors: systolic blood pressure (P = 0.009), diastolic blood pressure (P = 0.010), total cholesterol (P = 0.006), low-density lipoprotein cholesterol (LDL-c; P = 0.039), triglycerides (P = 0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P < 0.001). An increase in HDL-c (P = 0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6 % at the beginning of the study to 6.4 % after 12 months (P = 0.039). The risk estimate according to REGICOR also decreased (P = 0.002). Over the 12-month period, 6.3 ± 3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy.
authors.affiliation: Federal University of Mato Grosso do Sul, Avenida Senador Filinto Muller, s/n, Campo Grande, MS, CEP 79080-190, Brazil. eadomingues@yahoo.com.br.|Doctoral Programme in Clinical Medicine and Public Health, Granada University, Granada, Spain. eadomingues@yahoo.com.br.
authors.forename: Elza Aparecida Machado
authors.identifier: http://orcid.org/0000-0001-7112-7066
authors.initials: EA
authors.lastname: Domingues
authors.affiliation: Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ferrit-Martín
authors.affiliation: Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Calleja-Hernández
mesh_terms: D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010607:Pharmacy Service, Hospital / Q000379:methods*; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; Older patients; Pharmaceutical care; Pharmacotherapy follow-up; Spain