The effect of cardiovascular credentialed pharmacists on process measures and outcomes in myocardial infarction and heart failure

Objective: The purpose of this study was to determine if institutions with inpatient cardiovascular credentialed pharmacists exhibit improved quality measures for acute myocardial infarction (AMI) and heart failure (HF) care compared with institutions without inpatient cardiovascular credentialed pharmacists.

Methods: We conducted a multicenter, retrospective, cross-sectional, matched case-control study. Hospitals with at least one Added Qualification in Cardiology (AQCV) inpatient pharmacist were included in the case group. Each case group hospital was matched to hospitals without an AQCV pharmacist by region, number of cardiovascular discharges, and teaching hospital designation in a 1:3 ratio (case:control). The 34 AQCV hospitals were matched to 102 non-AQCV hospitals. The proportions of discharges meeting HF and AMI process of care measures and 30-day outcomes (readmission and mortality) for each hospital were determined from public data and compared between the case and control groups.

Results: Hospitals with AQCV pharmacists performed better on process of care measures than hospitals without AQCV pharmacists (odds ratio 1.41, 95% confidence interval 1.25-1.58, p<0.0001, p<0.001 for heterogeneity), which was mainly driven by the aspirin on discharge for AMI and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker on discharge for HF measures. No differences were observed between the groups for either readmission or mortality at 30 days.

Conclusions: Hospitals that used inpatient AQCV pharmacists performed better on process of care measures than hospitals that do not use inpatient AQCV pharmacists. However, improvements in process of care performance measures observed in AQCV hospitals did not translate into improved 30-day clinical outcomes.