The Collaborative Cardiovascular Risk Reduction in Primary Care (CCARP) Study



Study Objective. To evaluate whether a simple pharmacist protocol, consisting of patient screening and cardiovascular risk stratification, identification and reminders about uncontrolled risk factors, and drug adherence support, can significantly reduce cardiovascular risk.

Design. Prospective, randomized, controlled pilot study.

Setting. Large primary care medical clinic in Saskatoon, Saskatchewan, Canada.

Patients. One hundred seventy-six adult patients (mean age 60 yrs) who exhibited a 10–year Framingham risk score of 15% or greater, or a coronary artery disease risk equivalent (coronary artery disease, peripheral artery disease, cerebrovascular disease, or diabetes mellitus).

Intervention. Eligible patients initially met with the pharmacist to receive general counselling about cardiovascular disease and were then randomly assigned to receive ongoing follow-up by the pharmacist (follow-up group [88 patients]) or to return to usual care (single-contact group [88 patients]) for a minimum of 6 months.

Measurements and Main Results. The primary end point was mean reduction in the 10–year Framingham risk score. Secondary end points included individual modifiable risk factors (systolic and diastolic blood pressures; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], and triglyceride levels; total cholesterol: HDL ratio; and hemoglobin A1c value), as well as statin utilization, initiation, and adherence rates. Baseline characteristics were similar across both groups. Neither the mean reduction in 10–year risk (−2.68 for the follow-up group and −1.25 for the single-contact group, one-tailed p=0.098) nor individual risk factors were significantly different between groups. The proportion of patients exhibiting statin adherence of 80% or greater did not significantly differ between groups at study end (73.1% [57/78] and 80.0% [52/65], respectively, p=0.333). However, 85.2% (75/88) in the follow-up group continued with statin therapy at the end of the study compared with 67.0% (59/88) in the single-contact group (p=0.005). Statin initiations were more frequent in the follow-up group than in the single-contact group (75.0% [30/40) vs 48.9% [22/45], p=0.013).

Conclusion. This simple cardiovascular care protocol for nonspecialist pharmacists did not result in a clear improvement to cardiovascular risk reduction success among patients in a primary care medical clinic. The intervention did, however, appear to improve statin utilization.