Sian Carr-Lopez, PharmD
Professor and Assistant Dean, Experiential Programs; University of the Pacific Inpatient Pharmacist, Kaiser Permanente Vacaville Medical Center
Where did you receive your education?
I attended Pharmacy School at the University of the Pacific and did an ASHP Residency at Martinez VA Medical Center.
At a time when heart disease is the leading cause of mortality in the US, what is your view on the importance of observing American Heart Month?
Any opportunity we have to focus on heart health is important. American Heart Month is a fantastic way to synergize our efforts to help patients and the public appreciate the significance of the problem, the symptoms that should prompt immediate medical attention, and important ways to prevent heart disease. However, to really impact this significant problem, a year-round commitment is needed. As pharmacists, we need to consider effective ways to help patients with cardiac conditions as they transition between different levels of care. We also need to implement an effective strategy for staying current with national treatment guidelines and landmark clinical trials so that we can positively impact prescribing and ensure patients are achieving optimal outcomes.
How did you get into the area of cardiovascular care?
Seven years ago, I transitioned from my position as the Regional Coordinator at Travis AFB to an on-campus position with the University of the Pacific. At Travis, I had been an internal medicine preceptor for students and residents for thirteen years, and dealt frequently with patients who suffered complications of heart disease progression. It was a natural fit for me to begin teaching the Cardiovascular Care Course at Pacific. A few years ago, I assumed the role of Faculty Liaison for Operation Heart, a student-driven community outreach program. I think my involvement with Operation Heart has complimented my tendencies towards acute care, and has enabled me to consider the problem of heart disease with a more global perspective.
Can you think of a specific patient case you’ve addressed that drives home the impact or importance of cardiovascular care or the need to educate the public on heart health?
On a personal level, a close friend is a heart transplant recipient. From a friend’s perspective, I have experienced the miracles of modern medicine including ECMO, ventricular assist devices and life-saving pharmacotherapy. Through her numerous hospitalizations, some lasting weeks in the intensive care unit, I have also experienced anxiety and frustration over the limitations of modern medicine. On a professional level, it is not a specific patient I think of, but a consistent experience in the hospital setting. When patients are hospitalized for a heart condition, pharmacists have a unique and powerful opportunity to help concerned patients and their loved ones identify and implement important lifestyle changes, including smoking cessation, eating a healthy diet, exercising or complying with optimal drug therapy.
In addition to patient education, I also believe that pharmacist education is critical to impacting cardiovascular outcomes. When health-system pharmacies implement professional development activities for their staff, it fosters a progressive practice environment. For example, the pharmacy leadership at Kaiser Vacaville Medical Center ensures that all pharmacists are ACLS certified so that when we respond to Code Blue or Trauma calls, we are more prepared to contribute to the healthcare team.
Have you been involved in any community service outreach projects/public relations within the area of cardiovascular care or American Heart Month?
For the academic year 2010 – 2011, the University of the Pacific’s Operation Heart provided comprehensive cardiovascular risk assessment for 421 participants at our community outreach events. So far in academic year 2011 – 2012, we have provided comprehensive screening for over 500 participants. During the outreach events, participants are also invited to participate in our research project, so informed consent is obtained. In addition to measuring and documenting blood pressure and cholesterol values, information including age, gender, weight, and whether they take blood pressure medications is collected. This enables us to calculate a global cardiovascular risk score which estimates their chance of having an event, such as a myocardial infarction, within the next ten years. We provide their risk score and educate individuals on ways to reduce risk. Most of these outreach events are offered in communities with underserved populations, so in addition to providing these services, our research will have important implications for estimating cardiovascular risk in these groups. Another activity at some of our community outreach is to examine combination drug therapy and see if participants at our events are receiving the ‘preferred’ or ‘acceptable’ combinations as defined by the American Society of Hypertension.
Does your health-system do anything to recognize this health observance?
Absolutely! The Operation Heart students are busy planning their events now. I hope that every health-system pharmacy will participate in American Heart Month. There are so many ways to get involved. Some may be drawn to the “Go Red for Women” program. Others may want to raise money for the American Heart Association by participating in heart walks, weight loss or exercise challenges. Others may offer health screenings or public education events. I really encourage the use of Global Cardiovascular Risk Assessment which can provide patients with a risk score as well as their heart age. These are powerful ways to communicate urgency to individual patients. Any time a patient or the public has an opportunity to interact with pharmacists, technicians and pharmacy students, we can change the way they live AND the way they perceive the profession of pharmacy
Do you have any ideas on how we can expand the role of pharmacists within the area of cardiovascular care? What are you currently doing in this area? Do you know of any unique practices that others are doing?
Cardiovascular disease is so common that any pharmacist with direct patient care responsibilities will encounter opportunities to improve patient outcomes. Examples of expanding roles in direct patient care include transitional care pharmacists and emergency department pharmacists. Some pharmacists work specifically in cardiovascular care units or clinics, so offering post-graduate experiences in these areas will help develop the next generation of specialty practitioners. Whether a generalist or specialist, pharmacists are an integral part of the patient care team. A focus on patient and public education, ensuring the use of evidence-based medicine, ensuring continuity of care between ambulatory and acute care, and a commitment to conducting research projects that provide answers, particularly for underserved or under-represented populations, is essential.
Interview by Andrea Hinton