Transthyretin Amyloid Cardiomyopathy Risk Evaluation in a Cohort of Patients With Heart Failure.

Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, infiltrative form of heart failure (HF). Nevertheless, ATTR-CM is a largely underrecognized and misdiagnosed condition. This study's objective was to develop an efficient model to assess the chance of ATTR-CM in patients with HF.

Switching from Biologic to Biosimilar Products: Insight from an Integrated Health Care System.

Biologics are indicated for the treatment of a wide range of conditions and have transformed care in several therapeutic areas; however, they are expensive for both health care systems and patients. The use of biosimilars, which are approved by the US Food and Drug Administration as being "highly similar" to the originator biologic, has the potential to change the health care landscape in the biologic space through considerable cost savings for both payors and patients. With the introduction of biosimilars, organizations are increasingly evaluating how to switch patients from originator biologics to biosimilars.

Clinical outcomes of dabigatran use in patients with non-valvular atrial fibrillation and weight >120 kg.

Background: Patients with obesity were underrepresented in studies evaluating the safety and effectiveness of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation (NVAF). This study compared clinical outcomes in patients with NVAF and weighing >120 kg and ≤120 kg who were receiving dabigatran.

Materials And Methods: This retrospective, matched, longitudinal cohort study included patients from three integrated healthcare delivery systems.

Using pharmacy technicians and electronic health record capabilities to improve outcomes for patients with cardiovascular disease.

Objective: This study aimed to compare lipid and blood pressure (BP) control before and after implementing a certified pharmacy technician (CPhT) protocol that optimized electronic health record (EHR) capabilities and shifted work from clinical pharmacy specialists (CPSs) to CPhT.

Setting: Kaiser Permanente Colorado's pharmacist-managed cardiac risk reduction service (which manages dyslipidemia, hypertension, and diabetes for all patients with atherosclerotic cardiovascular disease).

Practice Description: In 2019, a protocol that optimized EHR capabilities and allowed work to be offloaded from CPS to CPhT was implemented.

Fixed-Dose Combination Medications for Treating Hypertension: A Review of Effectiveness, Safety, and Challenges.

Purpose Of Review: To summarize the recent evidence on the effectiveness and safety of antihypertensive fixed-dose combination (FDC) medications, and to describe the facilitators and barriers to implementing FDCs in US clinical practice.

Recent Findings: Recent clinical practice guidelines include FDC use for treating high BP. Clinical trials in recent years support the use of antihypertensive FDCs including low-dose triple- and quadruple-therapy FDCs.

Value of Pharmacy Students Performing Population Management Activity Interventions as an Advanced Pharmacy Practice Experience.

To assess the value of an advanced pharmacy practice experience in which students engaged in population health management (PHM) activities for a managed care setting. Students were provided with a list of patients, trained on the requirements for each PHM activity and completed them independently. The students reviewed the electronic record for each patient on their list to identify those who were non-adherent to dual antiplatelet therapy (DAPT) within one year of coronary stent placement, non-adherent to beta blockers (BB) within six months post-acute myocardial infarction, or with renal dysfunction and requiring dose adjustment of lipid-lowering therapy.

Trends in high intensity statin use among secondary prevention patients 76 years and older.

Background: High intensity statin therapy (HIST) is the gold standard therapy for decreasing the risk of recurrent atherosclerotic cardiovascular disease (ASCVD); however, little is known about the use of HIST in older adults with ASCVD.

Objectives: The aim of this cross-sequential study was to determine trends in statin intensity in older adults over a 10-year timeframe.

Methods: The study was conducted in an integrated healthcare delivery system.

Trends in high-intensity statin use and low-density lipoprotein cholesterol control among patients enrolled in a clinical pharmacy cardiac risk service.

Background: Although high-intensity statin therapy (HIST) is recommended for most patients between 21 and 75 years of age with atherosclerotic cardiovascular disease (ASCVD), several recent analyses examining contemporary statin use trends have identified a clinical care gap in the utilization of HIST.

Objective: The objective of this study was to assess secular trends in lipid management for patients with ASCVD enrolled in a clinical pharmacy program within an integrated health care delivery system.

Methods: We performed serial cross-sectional studies over time, comprising 18,006 adults with both acute and chronic ASCVD, to assess trends in statin use and low-density lipoprotein cholesterol (LDL-C) levels from 2007 to 2016.

Evaluation of the Effect of A Structured Program to Guide Residents' Experience in Research (ASPIRE) on Pharmacy Residents' Knowledge, Confidence, and Attitude toward Research.

Study Objective: To evaluate the effect of A Structured Program to guide Resident Experience in Research (ASPIRE) on pharmacy residents' knowledge, confidence, and attitude toward research.

Design: Nonrandomized controlled study using data from a validated questionnaire administered through an online survey.

Participants: Of 60 pharmacy residents (residency year 2013-2014) who completed the baseline assessment, the 41 residents who also completed the follow-up assessment were included in the final analysis; of those, 26 Colorado pharmacy postgraduate year 1 (PGY1) and year 2 (PGY2) residents were enrolled in ASPIRE between July 2013 and June 2014 (intervention group) and 16 PGY1 and PGY2 pharmacy residents outside of Colorado did not participate in ASPIRE (control group).

Self-Rated Health Among Patients with Coronary Artery Disease Enrolled in a Cardiovascular Risk Reduction Service.

Little is known about the use of the single self-rated health (SRH) status item measuring health-related quality of life among people with coronary artery disease (CAD). The objective of this study was to assess relationships between SRH and recurrent coronary events, mortality, health care utilization, and intermediate clinical outcomes and to assess predictors of fair/poor SRH. A total of 5573 patients enrolled in a comprehensive cardiac risk reduction service managed by clinical pharmacy specialists were evaluated over a 2-year period.

Cluster-Randomized Trial of Clinical Pharmacist Tobacco Cessation Counseling Among Patients with Cardiovascular Disease.

Optimal management of patients with cardiovascular disease (CVD) includes evaluation of risk factors using a team-based approach. Tobacco use often receives less attention than other CVD risk factors; therefore, utilization of nonphysician health care providers may be valuable in addressing tobacco use. The purpose of this trial was to assess the impact of brief, structured, telephone tobacco cessation counseling (BST) delivered by clinical pharmacists on tobacco cessation attempts compared to usual care.

Impact of a clinical pharmacy research team on pharmacy resident research.

Purpose: A successful initiative by Kaiser Permanente Colorado (KPCO) to support pharmacy resident research projects and the publication of project results in peer-reviewed journals is described.

Methods: An observational study was conducted to evaluate the publication rates for resident research projects before and after the KPCO pharmacy department established a Clinical Pharmacy Research Team (CPRT) to encourage and enable resident research. All projects presented by KPCO residents at the annual Western States Conference (WSC) for Pharmacy Residents, Fellows, and Preceptors in the 10 years before the CPRT was established (1994-2004, the pre-CPRT group) and the 7 years after CPRT implementation (2005-11, the CPRT group) were included in the analysis.

Use of a pharmacy technician to facilitate postfracture care provided by clinical pharmacy specialists.

Purpose: The ability of a pharmacy technician to support the patient screening and documentation-related functions of a pharmacist-driven osteoporosis management service was evaluated.

Methods: A two-phase prospective study was conducted within a large integrated health system to assess a pharmacy technician's performance in supporting a multisite team of clinical pharmacy specialists providing postfracture care. In phase I of the study, a specially trained pharmacy technician provided support to pharmacists at five participating medical offices, helping to identify patients requiring pharmacist intervention and, when applicable, collecting patient-specific clinical information from the electronic health record.

Cost-effectiveness evaluation of a home blood pressure monitoring program.

Objectives: To evaluate the health system cost of a home blood pressure monitoring (HBPM) program versus usual care in an integrated healthcare system.

Study Design: This cost-effectiveness analysis was based upon a previously completed randomized controlled trial of 348 hypertensive patients, in which mean systolic blood pressure (BP) was lowered 21 versus 8 mm Hg in the HBPM and usual care groups, respectively, and BP control was achieved in 54% versus 35% of patients (P < .001).

Positive predictive values of ICD-9 codes to identify patients with stroke or TIA.

Objectives: To determine the positive predictive values of inpatient and outpatient ICD-9 codes and status code V12.54 for identifying confirmed history of stroke or transient ischemic attack (cerebral event) among patients within a managed care organization.

Study Design: Retrospective, cohort study.

Ambulatory treatment gaps in patients with ischemic stroke or transient ischemic attack.

Background: This study evaluated goal attainment for patients with a history of non-cardioembolic ischemic stroke (NCIS) or transient ischemic attack (TIA).

Methods: A cross-sectional study was conducted in patients aged 18 to 85 years with a history of validated NCIS or TIA. Data collected were demographics, comorbidities, blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) values, and medications within 365 days and most proximal to December 31, 2010.

Interventions aimed at improving performance on medication adherence metrics.

Background: medication adherence is one determining factor of treatment success. Poor medication adherence mitigates optimum clinical benefits and increases total health care costs. Current evidence suggests that for population-based adherence interventions to be effective, a multidisciplinary, multifactorial approach that can be tailored for each individual should be adopted.

Challenges to publishing pharmacy resident research projects from the perspectives of residency program directors and residents.

Objective: To identify barriers to completing and publishing pharmacy residency research projects from the perspective of program directors and former residents.

Methods: This was a cross-sectional survey of pharmacy residency program directors and former post-graduate year one and two residents. Directors of pharmacy residency programs whose residents present their projects at the Western States Conference (n=216) were invited to complete an online survey and asked to forward the survey to former residents of their program in 2009, 2010, or 2011.

A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program.

Background: To determine whether a pharmacist-led, Heart360-enabled, home blood pressure monitoring (HBPM) intervention improves blood pressure (BP) control compared with usual care (UC).

Methods And Results: This randomized, controlled trial was conducted in 10 Kaiser Permanente Colorado clinics. Overall, 348 patients with BP above recommended levels were randomized to the HBPM (n=175) or UC (n=173) groups.

Out-of-plan pharmacy use by members of a managed care organization.

Background: Bargain generic programs have proliferated rapidly since 2006. Little is known about the use of these programs. The purpose of this study was to assess the rate and characteristics of prescriptions written in a managed care organization (MCO) to an out-of-plan pharmacy (OOPP).

Publication rates of abstracts presented by pharmacy residents at the Western States Conference.

Purpose: Investigators report the results of a study to determine the proportion of residency projects presented as abstracts at a regional residency conference that were subsequently published as full-length articles.

Summary: Using every third item listed in the abstract booklets from the Western States Conference for the years 1995, 2000, and 2005, a search of MEDLINE and EMBASE for journal citations indicating publication of the corresponding residency projects was conducted; the searches covered a period including and extending five years beyond the year of abstract presentation at the conference. Of the total of 270 abstracts evaluated, 17 were expanded to full-length articles and published within the search time frame.

Systolic blood pressure control after participation in a hypertension intervention study.

Objective: To evaluate whether systolic blood pressure (SBP) control is maintained following participation in a multimodal hypertension intervention.

Study Design: This was a retrospective cohort of patients completing the Improving Blood Pressure in Colorado study, a randomized trial comparing a multimodal intervention with usual care for patients who had uncontrolled hypertension. Chart review assessed the first SBP measurement recorded as part of routine care after the study ended.

A multimodal blood pressure control intervention in 3 healthcare systems.

Objective: To determine if a multimodal intervention composed of patient education, home blood pressure (BP) monitoring, BP measurement reporting to an interactive voice response (IVR) phone system, and clinical pharmacist follow-up improves BP control compared with usual care.

Study Design: Prospective study with patient enrollment, medication consultation and adjustment, remote BP monitoring, and follow-up at 6 months.

Methods: This randomized controlled trial was conducted at 3 healthcare systems in Denver, Colorado, including a large health maintenance organization, a Veterans Affairs medical center, and a county hospital.

An assessment of cholesterol goal attainment in patients with chronic kidney disease.

Background: Patients with chronic kidney disease (CKD) are at significant risk for cardiovascular disease (CVD). The National Kidney Foundation developed clinical practice guidelines (Kidney Disease Outcomes Quality Initiative) for targeting low-density lipoprotein cholesterol (LDL-C) goals.

Objective: This study evaluated the extent to which these guidelines were adhered to among patients with CKD and to examine factors associated with the attainment of LDL-C goals.

Attainment of low-density lipoprotein cholesterol goals in coronary artery disease.

Background: The National Cholesterol Education Program Guidelines offer an optional low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dL for very high-risk patients with coronary artery disease (CAD). This study evaluated the extent to which this recommendation can be attained by the use of currently available lipid-lowering therapies.

Methods: A retrospective, cross-sectional study of patients in the Kaiser Permanente Colorado healthcare system 18 years of age or older with CAD and a predetermined LDL-C goal less than 70 mg/dL.