Pharmacist-led short term follow-up pilot program for acute coronary syndrome patients: a retrospective cohort study

Rural patients have been shown to have reduced access to care, delayed discharge-prescription fills, and frequent readmissions following acute coronary syndrome (ACS) compared to urban patients. While virtual and pharmacist-led programs have shown benefit in providing efficient care to cardiac patients, to our knowledge, their implementation in rural ACS-population have not been assessed. The purpose of this study was to determine the impact of pharmacist-led virtual follow-up program for rural ACS patients, compared to a matched control group. The intervention arm included 40 consecutive rural ACS-patients discharged from the Mazankowski Alberta Heart Institute between March-May 2022, as part of a pharmacist-led follow-up pilot-program. Structured telephone interviews were used to identify and resolve cardiac medication-related issues for each patient on day 1, 10, and 30 post discharge. Program-patients were compared to a control group (n=80) which included ACS patients (discharged November 2021-July 2022), matched for sex, zone of residence, and age within 10 years. Outcomes were collected from administrative databases and multivariable regression analyses were conducted for comparisons. The primary outcome was time to prescription fill of discharge ACS-medications within 30 days of discharge. Secondary outcomes included 30-day cardiac-related hospital readmissions, cardiac-related emergency department visits, and primary care practitioner (PCP)-visits. During the 15-week pilot-program, 139 virtual visits were completed. Median time spent per visit was 60 (interquartile range [IQR], 50-80) minutes. A total of 255 cardiac medication-related issues (6 per patient; IQR, 3.75-8.25) were identified, and 91% were resolved by the pharmacist. Prescription errors, adverse events, and therapy optimization were most common on day 1, 10, and 30 respectively. There was no significant difference between groups in time to prescription fill (0.25 [IQR, 0.0-0.25] days vs 0 [IQR, 0.0-1.0] days; hazard ratio [HR], 1.17; 95% confidence interval [CI], 0.80-1.73), cardiac-related hospital readmissions (8% vs 5%; odds ratio [OR], 1.54; 95% CI, 0.21-9.59), or cardiac-related emergency department visits (10% vs 8%; OR, 1.37; 95% CI, 0.27-6.18). PCP-visit was higher in program patients (90% vs 73%; HR, 3.00; 95% CI, 1.47-6.10). A significant number of cardiac medication-related issues were efficiently identified and resolved by pharmacist-led early follow-up program in rural post-ACS patients. Compared to matched control group, there was no difference in the time to ACS-medication prescription fill. Program-patients were more likely to have visits with their PCP following their ACS from program prompting, resulting in closer follow-up care. Further studies, with adequate power, are required to determine the impact on clinical outcomes.