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Study Objective. To determine which factors are associated with recurrent coronary events. Design. Matched, case-control study. Data Source. Electronic databases of a health maintenance organization. Patients. Of a cohort of adults (mean age 62 yrs, 68% male) who had an incident coronary event, defined as acute myocardial infarction or percutaneous coronary intervention, between January 1, 1999, and June 30, 2004, who survived and who were enrolled in a cardiac risk reduction service within 90 days after the incident event, 259 cases (patients who had a recurrent event between 90 days after the incident event and December 31, 2005) were matched with 688 controls (patients who did not have a recurrent event within this time frame). Measurements and Main Results. Multivariate conditional logistic regression was used to identify predictors of a recurrent coronary event. Although classic cardiac risk factors and drug therapies were similar for both groups at the time of the incident event, the mean low-density lipoprotein cholesterol (LDL) level, non-high-density lipoprotein cholesterol (non-HDL) level, and LDL:HDL ratio were higher and HDL levels were lower in the case patients compared with control patients (p

Study Objective. To determine the effect of early and sustained enrollment in a comprehensive cardiac care (CCC) program on all-cause mortality in patients with coronary artery disease (CAD). Design. Retrospective, longitudinal cohort study. Data Source. Kaiser Permanente Colorado tracking database. Patients. A total of 4896 patients with an incident occlusive CAD event (index event), defined as acute myocardial infarction and/or percutaneous coronary intervention with or without stent placement, between January 1, 1996 and June 30, 2004. Measurements and Main Results. All patients were categorized into one of four cohorts by time to enrollment into the CCC program relative to the index event: early CCC—enrolled less than 90 days after the index event (1630 patients), delayed CCC—enrolled 90 days or more after the index event (1211 patients), intermittent CCC—enrolled intermittently with noncontinuous care (483 patients), and no CCC—never enrolled (1572 patients). The primary outcome was all-cause mortality. Patients were censored at death from all causes, end of health plan membership, or study end (December 31, 2005), whichever came first. Patients with any exposure to the CCC were less likely to die compared with the no CCC cohort (p

Hypertension is a key risk factor for cardiovascular disease. Current management of hypertension, both pharmacologic and nonpharmacologic, is based on an extensive amount of published literature. We present a list of publications, clinical trials, meta-analyses, and clinical practice guidelines that we believe are essential in defining the current practice standards in the management of hypertension.

Hypercholesterolemia is a major risk factor for coronary heart disease, and data indicate that aggressive cholesterol reduction decreases mortality and morbidity associated with this disease. Many patients with hypercholesterolemia, however, are not screened, prescribed appropriate lipid-lowering therapy, or treated to target cholesterol levels. Practice patterns are particularly inadequate for those patients at highest risk for having a cardiac event. We performed a literature search to identify studies of practice patterns in the management of patients with hypercholesterolemia with regard to screening, implementing lipid-lowering therapy, and treating to lipid goals. The findings highlight the potential for substantial opportunities to improve patient outcomes. Future studies should evaluate reasons for suboptimal cholesterol management as well as provide steps to improve management.

Study Objective. To assess the impact of a collaborative cardiovascular risk reduction service (Collaborative Cardiac Care Service [CCCS]) on total health care expenditures after an incident acute coronary event. Design. Matched, retrospective cohort study. Data Source. Kaiser Permanente Colorado (KPCO) databases. Patients. Patients who had an incident coronary event between January 1999 and June 2004 and were either enrolled (CCCS group) or never enrolled in the CCCS (No CCCS group). Patients in the CCCS group (628 patients) were matched in a 1:1 ratio to patients in the No CCCS group (628 patients) by Chronic Disease Score (CDS) and total health care expenditures in the 180 days before the index coronary event (baseline). Measurements and Main Results. Drug purchases and medical utilization encounters were extracted from the KPCO administrative and claims databases after the incident coronary event until death, KPCO plan termination, 3 years later, or December 31, 2005, whichever came first (follow-up). Expenditure estimates from the plan's decision support system (in 2007 U.S. dollars) were applied to each utilization encounter. A$1/follow-up day cost was applied to all patients in the CCCS group. Expenditures/follow-up day were modeled with adjustment for matching variables, patient characteristics, baseline expenditures, and intracorrelations of matched patients. Patients in the No CCCS group were slightly older and were more likely to be female and have had a myocardial infarction as their incident event compared with those in the CCCS group. During follow-up, there were 12 and 98 cardiac-related deaths and 16 and 188 all-cause deaths for the CCCS and No CCCS groups, respectively; mean and median total health care expenditures/day were $39 and $20, respectively, for the CCCS group, and $108 and $45, respectively, for the No CCCS group (all p

Hypertension remains a major risk factor for cardiovascular disease. The optimal choice of pharmacologic and nonpharmacologic treatment regimens is based on a plethora of published literature. This compilation is the initial update to the Key Articles and Guidelines in the Management of Hypertension authored by members of the Cardiology Practice and Research Network of the American College of Clinical Pharmacy, which appeared in Pharmacotherapy in 2004. We present synopses of clinical trials, meta-analyses, clinical practice guidelines, and other pertinent literature published between May 2003 and June 2007.

In late 2002, the president of the American College of Clinical Pharmacy (ACCP), Mary Beth O’Connell, Pharm.D., charged the ACCP Research Affairs Committee with developing a White Paper on The State of Science and Research in Clinical Pharmacy. Its purpose would be to address the current state of research conducted by clinical pharmacists in terms of prevalence, scope, funding, location, and impact; describe the current state of research training for clinical pharmacists; envision the state of research conducted by future clinical pharmacists in 2030 and the training required for these future scientists, if ACCP’s vision is to be realized; describe any gaps that exist between current and envisioned states of clinical pharmacy research; and formulate recommendations to the profession and to ACCP in order to narrow any identified gaps. Member surveys, additional research, and committee deliberations in preparation for this White Paper began in October 2002. It is in accordance with these goals the following observations, analyses, and recommendations have been developed.

Peripheral arterial disease (PAD) affects approximately 8 million people in the United States, with less than half of these patients experiencing symptoms. The frequent asymptomatic presentation, combined with a lack of disease awareness by patients and health care practitioners, may result in missed diagnoses and inadequate treatment. Clinicians should recognize PAD as a marker of systemic atherosclerosis and appreciate the increased cardiovascular morbidity and mortality associated with the disease. Furthermore, intermittent claudication can significantly affect the quality of life of patients with acute and chronic leg ischemia. Consequently, a comprehensive treatment approach is needed, targeting both cardiovascular risk reduction and treatment of claudication pain. Although peripheral atherosclerosis can affect arterial beds throughout the body, our focus is on the key articles and guidelines addressing lower limb disease. We hope this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with PAD.