Pharmacists may be better at managing the recovery of stroke patients compared to trained nurses, according to a new study that could help improve care for the nearly one million Americans who suffer an attack each year.
The findings show that, while traditional nursing have helped countless patients back on track, assigning a pharmacist may lead to additional improvements in blood pressure and cholesterol levels following a stroke or a transient ischemic attack, also known as a “mini-stroke.” "We believe that both approaches hold great promise, not only for patients with stroke or transient ischemic attack but also for all patients with, or at high risk of, vascular disease, and our study provides much-needed information on their comparative effectiveness," said Dr. Finley McAlister, lead author and a researcher at the University of Alberta.
The study, which is published in the Canadian Medical Association Journal, featured 279 adult stroke victims. Participants were split into two groups: a treatment group receiving care from a pharmacist and a control group managed by a nurse. Over a period of six months, McAlister and colleagues tracked each participant’s progress by monitoring their blood pressure and cholesterol levels.
The team found that care managed by pharmacists was associated with 43 percent improvement across all factors at the end of the trial. For the control group, the figure was 30 percent. “Compared with nurse-led case management … active case management by pharmacists substantially improved risk factor control at 6 months among patients who had experienced a stroke,” the researchers wrote.
The findings persisted after the team controlled for diet, smoking, exercise, and other lifestyle factors known to influence recovery. Notably, the observed improvement was also obtained in patients who were already on medication at the start of the trial. "The 43% absolute improvement at 6 months seen in our pharmacist case manager group was achieved despite the fact that over three-quarters of patients were already taking an antihypertensive or lipid-lowering medication at baseline, “ McAlister explained.
Cardiovascular events like strokes currently account for about 600,000 fatalities each year, making it the leading cause of death in the United States. On average, deaths and illnesses associated with coronary heart disease cost the nation $109 billion annually.
The researchers theorize that the prescribing authority of pharmacists may contribute to their success as case managers. Many of them actively adjusted the medication each patient received, thus optimizing care with so-called medical titration.
Source: McAlister FA, Majumdar S, Padwal RS, et al. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized control trial. CMAJ. 2014.