Impact of intervention of community pharmacists on cardiovascular outcomes in Spain: A systematic review

Context: Cardiovascular disease (CVD) is one of the leading causes of morbidity and premature mortality across Spain. According to the World Health Organization (WHO), 80% of these premature deaths are preventable by controlling cardiovascular risk factors. Community pharmacists (CPs) are well situated to provide professional educational advice and implement interventions for the reduction of CVD. Aims: To analyze the impact of community pharmacists' interventions on cardiovascular risk factors and CVD prevention in Spain. Methods: Two independent reviewers searched PubMed/MEDLINE; SCOPUS; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; National Regional Database (LILACS BIREME); CINAHL; Pharm-line; ClinicalTrials.gov; ISRCTN; DOAJ (Directory of Open Access Journals), International Pharmaceutical Abstracts (IPA), the Spanish National Research Council (CSIC), WHO ICTRP, SCIELO and opengrey.eu and Google Scholar and considered research published between January 2000 and August 2020. The Cochrane risk of bias (RoB2) and ROBINS-I tools were used to evaluate the randomised/quasi-randomised controlled trials and the nonrandomised studies of interventions (NRSI), respectively. Results: The database search resulted in 457 items from which fourteen met our inclusion criteria. A total of 4,250 participants, aged 18 to 85, were included in the pharmacists' interventions offered in the form of medication reconciliation and patient education. Studies showed a beneficial effect of CPs intervention on medication reconciliation and the control of hypertension, dyslipidaemias, obesity, and diabetes. However, evidence on smoking cessation and alcohol advice services is meager. Conclusions: This study suggests that community pharmacist counselling and personalized intervention could contribute to improving cardiovascular outcomes in Spain.