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Case management by pharmacists of adults who had recently experienced a minor ischaemic stroke or transient ischaemic attack “substantially improved risk factor control” compared with nurse-led care, Canadian researchers report.

During the prospective randomised controlled study, nurses measured cardiovascular risk factors, counselled patients and faxed results to primary care physicians. Pharmacists did the same and also prescribed according to treatment algorithms. Patients attended monthly visits with a nurse or pharmacist for six months.

Most of the 279 patients received treatment at baseline, including 98.2 per cent taking antiplatelet drugs, 84.6 per cent receiving statins and 78.1 per cent on antihypertensives. Nearly two-thirds of patients had attained systolic blood pressure targets (≤ 140mmHg) at baseline.

After six months, 80.4 and 89.7 per cent of the pharmacist and nurse groups respectively met systolic blood pressure targets (the difference was not statistically significant). Patients managed by pharmacists had more medication changes (192 by pharmacists, 71 by physicians and 18 by patients) than in the nurse group (85 by physicians and 26 by patients).

At baseline, none of the patients met guideline targets for systolic blood pressure and fasting LDL cholesterol (≤ 2.0mmol/L) but, after six months, 43.4 and 30.9 per cent of patients in the pharmacist and nurse groups respectively met both targets. In particular, 51.1 and 33.8 per cent of patients managed by pharmacists and nurses respectively met the LDL target, which largely accounted for the difference between the two groups – a number-needed-to-treat of eight.

After controlling for age, co-morbidities, sex, smoking status and waist circumference, patients managed by pharmacists were more than twice (odds ratio 2.31) as likely to meet both targets at six months.