Article ID: 66464
Aim: A physician-led lipid-lowering protocol increased early proprotein convertase subtilisin/kexin type 9 inhibitor use after acute myocardial infarction (AMI), but workflow barriers remained. We evaluated a physician-pharmacist protocol-based pharmacotherapy management (PBPM) program designed to address these limitations.
Methods: This single-center observational study included 438 patients with AMI who underwent percutaneous coronary intervention and survived to discharge across PBPM (n = 162), physician-led (n = 160), and pre-protocol (n = 116) eras. The prespecified primary comparison was PBPM versus physician-led care. The primary and key secondary outcomes were evolocumab initiation and chronic-phase low-density lipoprotein cholesterol (LDL-C), respectively. Exploratory analyses examined outcomes across day-2 LDL-C treatment flows. Protocol adherence and reasons for non-initiation were also assessed.
Results: Evolocumab initiation increased across the pre-protocol, physician-led, and PBPM eras (2.6%, 13.1%, and 24.7%; overall P＜0.001) and was more frequent with PBPM than physician-led care (24.7% vs. 13.1%, P = 0.008), although the adjusted association was nonsignificant (odds ratio 2.01, 95% confidence interval 0.94-4.29; P = 0.071). Chronic-phase LDL-C was 49.0 versus 51.5 mg/dL (P = 0.074), whereas exploratory achievement of the contemporary LDL-C ＜55 mg/dL target was more frequent with PBPM (67.6% vs. 54.0%, P = 0.034). Among eligible patients, evolocumab initiation increased from 40.0% to 61.0% (P = 0.047), while system-related non-initiation decreased from 44.4% to 4.3%. Exploratorily, chronic-phase LDL-C was lower with PBPM among patients with day-2 LDL-C ≥ 90 mg/dL (24 vs. 47 mg/dL; P = 0.011; interaction P = 0.010).
Conclusions: PBPM was associated with greater adherence to the existing lipid-lowering protocol, more frequent evolocumab initiation at discharge, and fewer system-related reasons for non-initiation compared with physician-led care after AMI.
