Pharmacist-Led Optimisation Significantly Reduces Health Inequalities and Improves Lipid Control in Deprived Post-Acute Coronary Syndrome Patients

Abstract Background Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality, with outcomes disproportionately worse in socioeconomically deprived populations. Despite clear guideline recommendations, therapeutic inertia frequently prevents high-risk patients from achieving optimal lipid targets following acute coronary syndrome. This service evaluation assessed the impact of a pharmacist-led lipid optimisation clinic on lipid control and health inequalities in a high-risk post-acute coronary syndrome population. Methods This service evaluation was conducted at a tertiary cardiothoracic centre in the North East of England. A cohort of 816 post-acute coronary syndrome patients who had not achieved lipid targets were reviewed in a pharmacist-led clinic delivered by an independent prescriber. Lipid-lowering therapy was intensified in accordance with national guidance through face-to-face or telephone consultations. Primary outcomes were changes in non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol across three time points: baseline, following cardiology-led optimisation, and following pharmacist-led intervention. Planned comparisons using analysis of variance assessed changes over time. A secondary factorial analysis of variance examined differential effects by socioeconomic deprivation status, defined using the CORE20 metric. Results Of the 816 patients included, 698 (85%) were classified within the most deprived CORE20 group. Following pharmacist-led optimisation, mean non-high-density lipoprotein cholesterol decreased from 3.91 mmol/L to 2.32 mmol/L and mean low-density lipoprotein cholesterol decreased from 3.02 mmol/L to 1.60 mmol/L. Overall, 70% of patients achieved guideline-directed lipid targets, corresponding to a number needed to treat of four. Factorial analysis demonstrated a significant interaction between intervention stage and deprivation status, with patients in the CORE20 group experiencing greater absolute lipid reductions than non-CORE20 patients (mean low-density lipoprotein cholesterol reduction 1.55 mmol/L vs 1.29 mmol/L). Conclusions A pharmacist-led lipid optimisation clinic significantly improved lipid target attainment and disproportionately benefited patients from the most socioeconomically deprived backgrounds. This model represents a scalable strategy to reduce therapeutic inertia and mitigate health inequalities in secondary cardiovascular prevention. Trial Registration ​Clinical trial number: not applicable. This study was conducted as a service evaluation and quality improvement initiative and was not prospectively registered.