Impact of the Clinical Pharmacist on Readmission in Patients with Acute Coronary Syndrome

Acute coronary syndromes (ACS) encompass a spec-trum of clinical syndromes ranging from unstable angina (UA) to acute myocardial infarction (MI), includ-ing non–ST-segment elevation MI (NSTEMI) and ST-seg-ment elevation MI (STEMI). In 2002, the American Heart Association estimates there were approximately 942 000 hospital discharges associated with new-onset ACS. When secondary discharge diagnoses were taken into account, the number of hospitalizations nearly doubled to 1.7 million.1 Current recommendation for the management of STEMI includes primary percutaneous coronary intervention (PCI).2 Patients with NSTEMI and UA are managed by either early invasive or early conservative strategy. Early invasive strate-gy recommends patients for routine coronary angiography and revascularization whenever possible; however, early con-servative strategy reserves coronary angiography for patients who have recurrent ischemia, ST-segment changes at rest, positive stress test, or remain symptomatic despite optimal medical therapy. Chronic medical management of ACS usu-ally consists of therapy with antiplatelets, lipid-lowering agents, β-blockers, and angiotensin-converting enzyme (ACE) inhibitors for patients without contraindications.3 Clinical benefits of these medications have been extensively reported in large, randomized trials.2,3 Despite the advantages of these agents, one major reason for hospital readmission is patients ’ lack of adherence to prescribed medications.4-6 Studies have demonstrated the value of the pharmacist in improving patient outcomes in ambulatory care and acute care settings.7-13 The impact of pharmacist interven-tions on patient care in acute cardiac diseases was evaluat-ed in the hospital setting.10,11 Axtell et al.10 demonstrated that pharmacist intervention improved adherence to na-tional guidelines of medication prescribing for patients with acute MI. Luzier et al.11 showed significant reduction in costs related to rehospitalization in patients with hear