Help Patients Manage Heart Health Through Medication Therapy Management

February is American Heart Month, which is a great time for pharmacists to raise awareness about cardiovascular disease (CVD). The goal of the Million Hearts initiative, led by the CDC and Centers for Medicare & Medicaid Services, is to prevent 1 million myocardial infarctions and strokes within 5 years.¹ Through medication therapy management (MTM) and social media campaigns, pharmacists can help promote heart health (FIGURE).

Image credit: Fabio Balbi | stock.adobe.com

HEART HEALTH AND MTM

The US surgeon general’s 2020 report regarding hypertension emphasizes the important role pharmacists play in MTM services as part of the health care team.² This is especially critical to improve medication adherence to manage hypertension.² Evidence demonstrates MTM can improve CVD clinical outcomes such as blood pressure (BP), cholesterol, and hemoglobin A_1c.³

One systematic review of 45 studies evaluated community pharmacists’ roles in preventing and managing CVD.⁴ Additionally, the review assessed patients’ perceptions toward these pharmacists’ roles. There were 35 studies (78%) that reported the following CVD preventive roles⁴:

• Medicine and lifestyle counseling
• Health education
• Consultations and drug monitoring
• Adherence counseling
• Medication therapy review
• Physician referral
• CVD risk screening
• Self-care management
• Smoking cessation
• Treatment recommendations
• Pharmacist-initiated prescribing
• Patients were satisfied with pharmacist services in 10 of 11 studies.⁴

Pharmacists were described as empathetic, team players, and good communicators.⁴ As part of a multidisciplinary team, pharmacists can play an important role to ensure that aspirin therapy is used appropriately.⁵ This can include deprescribing aspirin on a case-by-case basis for individuals who do not qualify for primary prevention based on age and bleeding risk.⁵ The US Preventive Services Task Force (USPSTF) issued a recommendation statement in 2022 regarding aspirin therapy for primary prevention.⁵ Based on evidence, USPSTF does not recommend initiating aspirin therapy for primary prevention of CVD events in adults 60 years and older.⁵ Aspirin therapy in older adults increases the risk of gastrointestinal bleeding and intracranial hemorrhage.⁵ The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines do not recommend aspirin therapy for primary prevention for individuals older than 70 years or individuals at increased risk of bleeding.⁵ The ACC/AHA guidelines say low-dose aspirin (75 to 100 mg/day) could be considered for primary prevention in individuals aged 40 to 70 years at higher risk of CVD but with a low risk of bleeding.⁵

As part of the Million Hearts initiative, pharmacists can focus on the acronym ABCS to enhance heart health:⁶

A: Appropriate use of aspirin therapy

B: Control BP

C: Manage cholesterol

S: Don’t smoke

Lifestyle recommendations are an important part of MTM consults, especially when it comes to heart health. Pharmacists can provide tips for increasing physical activity such as walking, swimming, bike riding, and playing sports.⁷ The goal of the CDC’s Active People, Healthy Nation initiative is to support 27 million individuals in the US to become more physically active by 2027.⁷

Pharmacists can also promote American Heart Month through social media on various platforms such as Facebook and LinkedIn. The Million Hearts website includes videos, infographics, badges, and cards for these purposes.⁸

References

1. Home page. Million Hearts. Accessed December 7, 2023. https://millionhearts.hhs.gov/index.html

2. The surgeon general’s call to action to control hypertension. US Department of Health and Human Services. October 2020. Accessed December 10, 2023. https://www.cdc.gov/bloodpressure/docs/SG-CTA-HTN-Control-Report-508.pdf

3. Best practices for heart disease and stroke: a guide to effective approaches and strategies. Centers for Disease Control and Prevention. November 30, 2022. Accessed December 7, 2023. https://stacks.cdc.gov/view/cdc/122290

4. Motlohi NF, Wiafe E, Mensah KB, Padayachee N, Petrus R, Bangalee V. A systematic review of the role of community pharmacists in the prevention and control of cardiovascular diseases: the perceptions of patients. Syst Rev. 2023;12(1):160. doi:10.1186/s13643-023-02338-7

5. Davidson, KW, Barry MJ, Mangione CM, et al. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983

6. ABCs of heart health. Million Hearts. July 13, 2020. Accessed December 8, 2023. https://millionhearts.hhs.gov/data-reports/factsheets/ABCS.html

7. About active people, healthy nation. Centers for Disease Control and Prevention. July 6, 2023. Accessed December 8, 2023. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/about-active-people-healthy-nation.html

8. News & media. Million Hearts. Accessed December 8, 2023. https://millionhearts.hhs.gov/news-media/index.html