Effects of Pharmacist Interventions on Heart Failure Outcomes

Effects of Pharmacist Interventions on Heart Failure Outcomes
Taylor Grupa, PharmD, Essentia Health

Background: Heart failure is a complex condition associated with many adverse outcomes. Both non-pharmacological and pharmacological therapies, otherwise known as guideline-directed medical therapy (GDMT), have improved heart failure management. As patients’ medications regimens grow in complexity, there is great potential for medication harm among patients with heart failure. 

Purpose: A previously published review identified benefits from pharmacist involvement in heart failure care, including reductions in all-cause and heart-failure-related hospitalizations. More recently, additional studies have been published. This study aimed to evaluate recent trials with a focus on improving heart failure outcomes through pharmacist interventions. 

Study Design: This study was a systematic review and meta-analysis. After searching terms such as heart failure and pharmacist intervention, randomized controlled trials were included if studies assessed impacts of pharmacist interventions compared to usual or standard care and reported data on mortality, hospitalizations, and quality of life. 

Pharmacist interventions included: optimization of GDMT, improvements to patient adherence, provision of patient counseling, medication reconciliation, and identification and mitigation of adverse drug reactions. Pharmacist interventions were also assessed based on service setting and included a variety of practice settings, such as ambulatory settings, acute care settings, telephonic follow-up visits, and community based-settings, including community pharmacy or home-based care. 

The primary outcome was all-cause mortality and secondary outcomes included all-cause hospitalization, health-related quality of life (using the Minnesota Living with Heart Failure Questionnaire and 36-item Short Form Survey), and prescribing rates of GDMT. 

Results: Of the 15,107 articles screened, 29 randomized controlled trials were included for analysis. These studies included a total of 6965 patients, with predominantly heart failure with reduced ejection fraction and an average age of 72 years. Most patients were New York Heart Association Functional class II to III with median left ventricular ejection fraction of 38.5%, and the average number of medications per patient was 8 (IQR 6.8-8.9). 

Pharmacist interventions were associated with a significant reduction in all-cause mortality (RR 0.72 [95% CI 0.58-0.89]; P = 0.003) and all-cause hospitalizations (RR 0.87 [95% CI 0.77-0.99]; P = 0.041) compared to those receiving usual or standard care. Sub-group analysis by service setting noted a significant reduction in all-cause mortality with pharmacist intervention in all settings, except community-based settings. A significant increase in the 36-item Short form Health survey on physical and mental health and significant improvement in Minnesota Living with Heart Failure Questionnaire score were observed among those receiving pharmacist intervention. Pharmacist interventions also led to increases in the prescribing of ACE inhibitors/ARBs and beta blockers. 

Conclusion: Pharmacist interventions for heart failure patients significantly decreased rates of all-cause mortality and all-cause hospitalizations as well as increased quality of life. Differences observed based on practice setting suggest positive outcomes of pharmacist interventions are best achieved in an integrated care team. Integration of a pharmacist into an interprofessional heart failure care team should be considered to further optimize patient care.

Key Point: Pharmacist involvement in heart failure care improves patient outcomes and may be best implemented when the pharmacist is part of a multidisciplinary team.

 

Reference:

  1. Poukwan A, Kengkla K, Chaiyasothi T et al. Effects of pharmacist interventions on heart failure outcomes: a systematic review and meta-analysis. J Card Fail. 2020;26(10)1-31.