Risk stratification tool for pharmaceutical care in patients with cardiovascular disease.

Abstract

Objective: To develop a risk stratification tool for pharmaceutical care in patients with cardiovascular disease who require a comprehensive and personalized pharmaceutical approach.

Method: The risk stratification model was collaboratively developed by hospital pharmacists specialized in managing cardiovascular risk patients, all members of the Spanish Society of Hospital Pharmacy. Through three workshops and a pilot study, relevant variables were identified, grouped into four dimensions, and assigned relative weights. In the pilot study, data from patients in the participating centers were collected and analyzed to determine priority levels and assess the contribution of each variable. The Kaiser Permanente pyramidal model was adopted, classifying patients into three priority levels: priority 1 (intensive pharmaceutical care, 90th percentile), priority 2 (60-90th percentiles), and priority 3 (below the 60th percentile). Cut-off points were established based on this stratification, and each center recorded variables in an Excel sheet to calculate mean weighted scores per priority level and total risk scores.

Results: Participants completed a questionnaire consisting of 20 variables grouped into four dimensions: demographic, socio-health and functional status, clinical and healthcare utilization, and treatment-related factors. Based on the tool application in a pretest study, the following cut-off points were established: 23 or more points for priority 1, 17-22 points for priority 2, and fewer than 16 points for priority 3. Over 80% of the total score was attributed to the dimensions of "clinical and healthcare utilization" and "treatment-related factors". Consequently, interventions based on the pharmaceutical care model were recommended for cardiovascular risk patients, tailored to their prioritization level.

Conclusion: This stratification tool enables the identification of cardiovascular patients who require a higher level of pharmaceutical care, facilitating the adjustment of healthcare capacity. Validation of the model in a representative population is necessary to establish its broader applicability.