Optimizing antiplatelet therapy to reduce vascular events in high-risk patients
Our primary objective in sharing this information is simple: Demonstrate the success Coordinated Care is experiencing through engagement and collaboration with clinical pharmacists across the clinically integrated network, including those from the University of Colorado Skaggs School of Pharmacy, CU Medicine’s Office of Value Based Performance, the University of Colorado Hospital Department of Pharmacy, Associates in Family Medicine, and those working at UCHealth community pharmacies in the north and south. We are making a measurable difference, and we look forward to sharing additional insights in the near future.
Antiplatelet therapy with aspirin or clopidogrel can reduce the risk of myocardial infarction, stroke and vascular death in patients with established atherosclerotic vascular disease by more than 20 percent. Despite these important benefits, preliminary findings within Coordinated Care suggest that 10-15 percent of high-risk patients are not appropriately receiving this therapy. For patients without established vascular disease, the evidence for aspirin is less clear, presenting challenges when determining which patients need therapy.
Clinical pharmacists across the Network strive to improve the use of aspirin therapy in high-risk patients. Using work begun by CU Medicine’s Office of Value Based Performance, clinical pharmacists work with the Denver Internal Medicine Group clinic, as well as the Snow Mesa Internal Medicine Clinic in Fort Collins, to identify patients within the Medicare Shared Savings Program (MSSP) with established vascular disease, but no aspirin therapy was documented in their medical record.
Approximately 35 percent of identified patients were able to initiate aspirin, 15 percent were already taking it but needed documentation, and 30 percent had at least one contraindication for therapy (e.g., older age or bleeding risk). There were patients not interested in initiating therapy, as well as patients with no clear diagnosis of atherosclerosis upon chart review. With this collaborative work, nearly 95 percent of MSSP patients at high risk for vascular disease at these two clinics are receiving antiplatelet therapy.
The data supporting use of antiplatelet therapy for both primary and secondary cardiovascular prevention has been summarized in the accompanying article. It is hoped this information can improve the appropriate use of antiplatelet therapy for patients who will most benefit from this therapy. I look forward to any insights or best practices you have to share.
Joseph Vande Griend, PharmD, BCPS, BCGP
Director of Population Health Pharmacy