Development and Validation of Cardiology-Specific Quality Indicators for Clinical Pharmacists: A Modified Delphi Study

Background: Clinical pharmacists play a critical role in cardiology by optimizing pharmacotherapy and improving patient outcomes. However, despite their growing importance, standardized quality indicators to evaluate their impact in clinical practice remain lacking. Objective: This study aimed to develop and validate a set of cardiology-specific Quality Indicator Drug Therapy Problems (QI-DTPs) defined as medication-related quality indicators focused on identifying, preventing, and resolving drug therapy problems-using a modified Delphi technique in Saudi Arabia. Methods: Twenty-three candidate QI-DTPs were developed based on a comprehensive review of current cardiology guidelines and evidence-based literature, refined by an expert advisory group. A panel of sixteen experienced clinical pharmacists with cardiology expertise from Saudi Arabia evaluated these indicators using a modified Delphi approach conducted over three iterative rounds. Each indicator was rated on a nine-point Likert scale (1 = strong disagreement to 9 = strong agreement). Indicators achieving ≥75% consensus were considered validated. Results: Sixteen expert clinical pharmacists participated (69% male, 31% female), most of whom had completed a pharmacy residency and had cardiology-related clinical experience. High levels of agreement were achieved across the Delphi rounds, and all 23 proposed QI-DTPs met the predefined ≥75% consensus threshold, demonstrating strong agreement regarding their relevance, clarity, and applicability in cardiology practice. Conclusion: The study successfully identified and validated 23 QI-DTPs, reflecting strong consensus among clinical pharmacists in Saudi Arabia. Implementation of these indicators in clinical practice could enhance the quality of cardiovascular care, reinforce pharmacist-led interventions, and promote medication safety. Future research should assess the direct impact of these quality metrics on patient outcomes.