Clinical pharmacist intervention reduces mortality in patients with acute myocardial infarction: A propensity score matched analysis

Abstract

Background Is it possible that the mortality rate from acute myocardial infarction (AMI) may decline after interventions by pharmacists? Objective To evaluate the impact of clinical pharmacist on the mortality of AMI. Methods Clinical pharmacists did not perform any interventions during phase 1 (pre-intervention), and consulted with physicians to address drug related problems (DRPs) during phase 2 (post-intervention). The main outcome was a decrease in mortality from AMI. The two phases were compared using propensity score matching (PSM). Results 1388 interventions were suggested by clinical pharmacists during phase 2, of which 1239 (89.2%) were accepted. Logistic regression analysis demonstrated that interventions of clinical pharmacists were significantly associated with a reduced mortality in patients with both ST segment elevation myocardial infarction (STEMI) (OR 0.449; 95% CI 0.296 to 0.680) and non-ST segment elevation myocardial infarction (NSTEMI) (OR 0.268; 95% CI 0.125 to 0.572). Using PSM analysis, mortality reduced from 6.8% to 4.3% in STEMI patients (P=0.0034) and from 3.2% to 0.7% in NSTEMI patients (P=0.0202) after the interventions. Conclusions DRPs that caused or contributed to possible mortality were detected by clinical pharmacists in patients with AMI. Correcting these DRPs after pharmacists' interventions could result in a significant decrease in mortality.