American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, Jan 15, 2015
Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists wi... more Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists with independent prescribing authority are reported. A Web-based questionnaire was used to collect data on the prescribing activities of a designated group of hospital-affiliated pharmacists in the province of Alberta who had been granted "additional prescribing authorization" (APA) through a peer-review process and were providing clinical pharmacy services in inpatient and/or outpatient settings at the time of the survey (January-March 2014). Descriptive statistics and logistic regression analysis were used to determine the median weekly frequency of prescribing, factors associated with increased use of APA, and perceived prescribing barriers and enablers. The survey response rate was about 50% (77 of 153 eligible pharmacists). The median self-reported number of prescriptions and medication orders written during an average week was 4.2 (interquartile range, 2.0-10.0) per 10 pati...
73 M Berresheim, AR Barry, CM Norris, SL Koshman, J Nagendran, GJ Pearson. Real-life practice in ... more 73 M Berresheim, AR Barry, CM Norris, SL Koshman, J Nagendran, GJ Pearson. Real-life practice in the management of new-onset postoperative atrial fibrillation early after cardiac surgery. Curr Res Cardiol 2015;2(2):73-76.
AR Barry, Sl koshman, Gj Pearson. Efficacy and safety of mineralocorticoid receptor antagonist th... more AR Barry, Sl koshman, Gj Pearson. Efficacy and safety of mineralocorticoid receptor antagonist therapy in heart failure with reduced ejection fraction. Curr Res Cardiol 2014;1(2):84-88. oBjECTIVES: To summarize the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) compared with placebo for the treatment of heart failure with reduced ejection fraction (HFrEF) by assessing clinically relevant end points of randomized controlled trials.
The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF... more The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.
The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides disc... more The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides discussion on the management recommendations on 3 focused areas: (1) anemia; (2) biomarkers, especially natriuretic peptides; and (3) clinical trials that might change practice in the management of patients with heart failure. First, all patients with heart failure and anemia should be investigated for reversible causes of anemia. Second, patients with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved systolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers to best manage patients with heart failure.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2012
FCSHP, FACC Study Objective. To evaluate the effect of pharmacist care on patients with dyslipide... more FCSHP, FACC Study Objective. To evaluate the effect of pharmacist care on patients with dyslipidemia. Design. Systematic review of 21 randomized controlled trials. Patients. A total of 5416 patients who received enhanced pharmacist care or standard care as part of a research study. Measurements and Main Results. Nineteen databases and four trial registries were systematically searched from inception through February 21, 2010, with an update in September 2011.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2014
To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of pati... more To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of patients who underwent coronary artery bypass graft (CABG) surgery—including specific drugs and their dosages, drug adherence, and assessment of targeted therapy--from admission to 1 year after CABG surgery. Retrospective analysis. Cardiovascular quaternary care medical center in Edmonton, Canada. The entire cohort consisted of 1031 adults who underwent CABG surgery between January 2009 and March 2010; a randomly selected subset of 151 patients was used to evaluate medication use and target-directed therapy at 1 year after CABG surgery. Utilization rates of aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEIs/ARBs) on admission and at discharge were determined for the entire cohort by using data from a large clinical patient registry. The proportion of patients discharged receiving all four classes of medications was 35%. Individual utilization rates for aspirin, β-blockers, and statins were 96%, 94%, and 95%, respectively; use of ACEIs/ARBs was lowest at 42%. In the 1-year post-CABG surgery substudy, medication use and target-directed therapy at 1 year after CABG surgery were evaluated by using community pharmacy and electronic health records. The proportion of patients receiving all four classes of medications at 1 year was 48%. Individual utilization rates for aspirin, β-blockers, statins, and ACEIs/ARBs were 95%, 84%, 84%, and 65%, respectively. Medication adherence, assessed by the medication possession ratio, for β-blockers, statins, and angiotensin-modulating agents at 1 year exceeded 0.85, thereby demonstrating high adherence. Evaluation of target-directed treatment of dyslipidemia and diabetes mellitus demonstrated suboptimal control, with only 66% and 54% of patients, respectively, achieving the recommended therapeutic targets. The utilization rate for patients receiving all four classes of secondary prevention cardiovascular medications was 35% at discharge and 48% at 1 year after CABG surgery. These rates were primarily limited by the low utilization of angiotensin-modulating agents, although their rate improved by 22% from discharge. Utilization rates, however, were high for aspirin, β-blockers, and statins both at discharge and 1 year after surgery. Opportunities remain to further optimize secondary prevention cardiovascular pharmacotherapy in patients who undergo CABG surgery, either while in the hospital or immediately subsequent to discharge.
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, Jan 15, 2015
Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists wi... more Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists with independent prescribing authority are reported. A Web-based questionnaire was used to collect data on the prescribing activities of a designated group of hospital-affiliated pharmacists in the province of Alberta who had been granted "additional prescribing authorization" (APA) through a peer-review process and were providing clinical pharmacy services in inpatient and/or outpatient settings at the time of the survey (January-March 2014). Descriptive statistics and logistic regression analysis were used to determine the median weekly frequency of prescribing, factors associated with increased use of APA, and perceived prescribing barriers and enablers. The survey response rate was about 50% (77 of 153 eligible pharmacists). The median self-reported number of prescriptions and medication orders written during an average week was 4.2 (interquartile range, 2.0-10.0) per 10 pati...
73 M Berresheim, AR Barry, CM Norris, SL Koshman, J Nagendran, GJ Pearson. Real-life practice in ... more 73 M Berresheim, AR Barry, CM Norris, SL Koshman, J Nagendran, GJ Pearson. Real-life practice in the management of new-onset postoperative atrial fibrillation early after cardiac surgery. Curr Res Cardiol 2015;2(2):73-76.
AR Barry, Sl koshman, Gj Pearson. Efficacy and safety of mineralocorticoid receptor antagonist th... more AR Barry, Sl koshman, Gj Pearson. Efficacy and safety of mineralocorticoid receptor antagonist therapy in heart failure with reduced ejection fraction. Curr Res Cardiol 2014;1(2):84-88. oBjECTIVES: To summarize the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) compared with placebo for the treatment of heart failure with reduced ejection fraction (HFrEF) by assessing clinically relevant end points of randomized controlled trials.
The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF... more The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.
The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides disc... more The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides discussion on the management recommendations on 3 focused areas: (1) anemia; (2) biomarkers, especially natriuretic peptides; and (3) clinical trials that might change practice in the management of patients with heart failure. First, all patients with heart failure and anemia should be investigated for reversible causes of anemia. Second, patients with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved systolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers to best manage patients with heart failure.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2012
FCSHP, FACC Study Objective. To evaluate the effect of pharmacist care on patients with dyslipide... more FCSHP, FACC Study Objective. To evaluate the effect of pharmacist care on patients with dyslipidemia. Design. Systematic review of 21 randomized controlled trials. Patients. A total of 5416 patients who received enhanced pharmacist care or standard care as part of a research study. Measurements and Main Results. Nineteen databases and four trial registries were systematically searched from inception through February 21, 2010, with an update in September 2011.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2014
To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of pati... more To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of patients who underwent coronary artery bypass graft (CABG) surgery—including specific drugs and their dosages, drug adherence, and assessment of targeted therapy--from admission to 1 year after CABG surgery. Retrospective analysis. Cardiovascular quaternary care medical center in Edmonton, Canada. The entire cohort consisted of 1031 adults who underwent CABG surgery between January 2009 and March 2010; a randomly selected subset of 151 patients was used to evaluate medication use and target-directed therapy at 1 year after CABG surgery. Utilization rates of aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEIs/ARBs) on admission and at discharge were determined for the entire cohort by using data from a large clinical patient registry. The proportion of patients discharged receiving all four classes of medications was 35%. Individual utilization rates for aspirin, β-blockers, and statins were 96%, 94%, and 95%, respectively; use of ACEIs/ARBs was lowest at 42%. In the 1-year post-CABG surgery substudy, medication use and target-directed therapy at 1 year after CABG surgery were evaluated by using community pharmacy and electronic health records. The proportion of patients receiving all four classes of medications at 1 year was 48%. Individual utilization rates for aspirin, β-blockers, statins, and ACEIs/ARBs were 95%, 84%, 84%, and 65%, respectively. Medication adherence, assessed by the medication possession ratio, for β-blockers, statins, and angiotensin-modulating agents at 1 year exceeded 0.85, thereby demonstrating high adherence. Evaluation of target-directed treatment of dyslipidemia and diabetes mellitus demonstrated suboptimal control, with only 66% and 54% of patients, respectively, achieving the recommended therapeutic targets. The utilization rate for patients receiving all four classes of secondary prevention cardiovascular medications was 35% at discharge and 48% at 1 year after CABG surgery. These rates were primarily limited by the low utilization of angiotensin-modulating agents, although their rate improved by 22% from discharge. Utilization rates, however, were high for aspirin, β-blockers, and statins both at discharge and 1 year after surgery. Opportunities remain to further optimize secondary prevention cardiovascular pharmacotherapy in patients who undergo CABG surgery, either while in the hospital or immediately subsequent to discharge.
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