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

Asma M Alshahrani,1 Mohammed Ahmed Alishaq,2 Manea Fares Al Munjem,2 Abdullah Sameer Alshammari,3 Geetha Kandasamy,4 Eman Shorog4 1Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Dawadimi, Saudi Arabia; 2King Khalid Hospital Najran Health Cluster, Najran, Saudi Arabia; 3Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Asma M Alshahrani, Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Dawadimi, Saudi Arabia, Email a.alshahrani@su.edu.saBackground: 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.Keywords: clinical pharmacy, cardiology, Delphi method, drug therapy problems, quality indicator–drug therapy problems, medication optimization, pharmacist led interventions