Alexander J. Blood

Purpose of Review To review community-based pharmacist-led medication titration across cardiometabolic conditions and the infrastructure needed to deliver this model at scale. Recent Findings This review reframes cardiometabolic medication optimization as a continuum from passive gap identification to active longitudinal medication management. Registries, dashboards, audit and feedback, electronic health record alerts, and inpatient initiation can identify undertreatment or prompt prescribing, but they do not provide infrastructure for dose adjustment, monitoring, adherence support, and medication-access navigation. Pharmacist-led, team-based models occupy the active end of this continuum. The strongest evidence is in hypertension, with meaningful blood pressure reductions; in heart failure, interdisciplinary titration programs more directly address target-dose achievement than alerts or decision-support tools. Emerging data extend this framework to diabetes, lipidology, and obesity. Value-based care provides a reimbursement framework to support these services. Summary Pharmacist-led titration can close gaps between therapies and delivery, but scaling requires equity-focused implementation, flexible staffing, population health infrastructure that connects artificial intelligence-enabled patient identification to action, and sustainable reimbursement.

Rentzepis et al. (2026) offer a comprehensive framework of seven ethical elements to consider when using artificial intelligence (AI) as part of clinical trial recruitment. In this commentary, we o...

Background: Despite overwhelming evidence of clinical benefit for patients with heart failure (HF), the uptake of guideline‐directed medical therapies (GDMT) has been slow. Collaborative approaches are critically needed to improve alignment between evidence and clinical practice. Many strategies proposed to improve GDMT implementation have been either ineffective or too resource‐intensive to implement at scale across different practice contexts. Furthermore, most existing approaches focus primarily on patients with HF and reduced EF, despite growing evidence for effective pharmacologic therapy in those with HF and mildly reduced or preserved ejection fraction (HFpEF). Hypothesis: Based on this experience, we designed the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT‐HF) study (NCT05734690). Methods: This is a pragmatic, randomized, open‐label intervention trial to compare a comprehensive, remote, navigator‐led, algorithm‐driven strategy for optimization of GDMT prescribing in patients with HF across the full spectrum of ejection fraction with a control intervention focused on patient and provider education regarding the importance of GDMT optimization. Results: The primary efficacy endpoint of the study is the proportion of patients receiving optimal HF treatment at 3 months. Additional outcomes of interest include the proportion of patients with optimal HF therapy at 6 months and 12 months as well as health resource utilization, including hospitalizations and deaths. Conclusions: COPILOT‐HF will evaluate the effectiveness of an early implementation of a remote pharmacist‐led medication titration strategy across the HF spectrum.

BACKGROUND: Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program’s long-term effects by examining participants’ office BP up to 42 months post-enrollment. METHODS: Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled–early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group. RESULTS: Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values ( P 50 years was associated with above-goal systolic BP in the maintenance group. CONCLUSIONS: Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.

This randomized clinical trial compares the efficiency of prescreening patients with heart failure using an artificial intelligence (AI) large language model for inclusion in a clinical trial vs manual prescreening.

Introduction/Objectives: Patients living with chronic diseases require more medical attention, including more visits to primary care. However, primary care providers are overburdened, and this specialty is attracting fewer new providers than before. Clinical pharmacists can augment these efforts by improving disease state control. In this cohort study, we aimed to demonstrate a retail pharmacy hired and trained clinical pharmacist within a value-based primary care clinic network can improve hypertension (HTN) and type 2 diabetes mellitus (T2DM) control. Methods: In this cohort study, a pharmacist, enabled by a collaborative drug therapy management agreement, prescribed and titrated therapies for HTN and T2DM. Primary outcomes were pre- to post-index changes in hemoglobinA1c, systolic, and diastolic blood pressure (BP) measures. Results: The HTN cohort consisted of 43 patients and the T2DM cohort consisted of 125 patients. The difference-in-differences (β) in the HTN group was −10.2 mmHg ( P < .01) for systolic BP and −2.0 mmHg ( P = .42) for diastolic BP. The β in the T2DM group was −1.16% ( P < .001). Conclusions: Statistically significant reductions in systolic BP and hemoglobinA1c were observed in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into a value based primary care clinic may improve measures of chronic disease associated with morbidity and mortality.

Objective: The objective of this study was to describe the prevalence of obesity, obesity‐related conditions (ORCs), and antiobesity medication (AOM) eligibility and prescribing practice among eligible patients in a large health care system.Methods: In this cross‐sectional analysis of the multicenter Mass General Brigham health care system (Boston, Massachusetts) spanning 2018 to 2022, adults eligible for AOMs (BMI ≥ 30 kg/m² or BMI 27–29.9 kg/m² with ≥1 ORC) were identified. Among those AOM‐eligible, the prevalence of prescriptions for AOMs approved for long‐term weight management was evaluated.Results: Of 2,469,474 adults (mean [SD], age 53 [19] years; 57% female; BMI 28.1 [6.3] kg/m²), a total of 1,110,251 (45.0%) were eligible for AOMs. Of these, 69.4% (31.2% of overall cohort) had BMI ≥ 30 kg/m². AOM prescription was observed in 15,214 (1.4%) of all eligible patients, with female sex, younger age, higher BMI, commercial insurance, and greater ORC burden associated with higher prevalence of AOM prescriptions. Musculoskeletal disorders (54%) were the most common ORCs, with ≥2 ORCs observed in 62% of patients. Liraglutide 3.0 mg and semaglutide 2.4 mg were the most frequently prescribed AOMs (58% and 34% of all AOMs, respectively).Conclusions: Although nearly one‐half of all patients in a large health care system were AOM‐eligible by guidelines and regulatory labeling, only 1% of those who were eligible were prescribed AOMs.