PHARMACIST INTERVENTIONS TO IMPROVE CLINICAL OUTCOMES IN HEART FAILURE

Year 2025, Volume: 49 Issue: 1, 146 - 154, 20.01.2025

Yeşim Bulut , Muhammed Yunus Bektay

https://doi.org/10.33483/jfpau.1527228

Abstract

Objective: Heart failure (HF) is associated with poor outcomes, such as high mortality and hospitalization rates, and impaired quality of life (QoL). Pharmacist participations in a multidisciplinary care team have demonstrated to be beneficial in HF, which includes optimization of guideline-directed medical therapy (GDMT) and medication adjustment, optimizing the transition of care (ToC) and medication reconciliation, and providing patient education. The aim of this literature review is to investigate the impact of pharmacist interventions on HF, with the intention to improve clinical outcomes.
Result and Discussion: Randomized controlled trials evaluating the efficacy of pharmacist intervention in HF patients were reviewed, and 8 randomized controlled trials were included. The pharmacist interventions that were investigated in these studies were medication review, patient counseling, and patient education. The included studies demonstrated that pharmacist interventions may reduce prescribing errors, medication discrepancies, and drug-drug interactions (DDIs). Studies demonstrated that patient counseling and education provided by the pharmacist may improve QoL and patient knowledge in HF. The rest of the outcomes lacked significance. In order to develop this issue further, large-scale randomized controlled trials and large-scale meta-analyses should be conducted involving pharmacist interventions in HF.

Keywords

Clinical pharmacist, heart failure, pharmaceutical care, pharmacist intervention

Ethical Statement

The authors declare that ethics committee approval is not mandatory for this study.

Supporting Institution

Bezmialem Vakif University

Thanks

We would like to thank Bezmialem Foundation University, Department of Clinical Pharmacy for their support.

KALP YETERSİZLİĞİNDE KLİNİK SONUÇLARI İYİLEŞTİRMEYE YÖNELİK ECZACI MÜDAHALELERİ

Abstract

Amaç: Kalp yetersizliği (KY), yüksek mortalite ve hastaneye yatış oranları ve bozulmuş yaşam kalitesi gibi kötü sonuçlarla ilişkilendirilmiştir. Kılavuza yönelik tıbbi tedavi optimizasyonu ve ilaç düzenlemesi, bakım geçişi ve ilaç uzlaşısı, ve hasta eğitiminin sağlanmasını içeren multidisipliner bir bakım ekibinin içinde eczacı katkılarının KY’de faydalı olduğu gösterilmiştir. Bu literatür taramasının amacı, klinik sonuçları iyileştirmek amacıyla eczacı müdahalelerinin KY üzerindeki etkisini araştırmaktır.
Sonuç ve Tartışma: Kalp yetersizliği hastalarında eczacı müdahalelerinin etkinliğini değerlendiren randomize kontrollü çalışmalar taranmış ve 8 randomize kontrollü çalışma derlenmiştir. Bu çalışmalarda araştırılan eczacı müdahaleleri ilaç incelemesi, hasta danışmanlığı ve hasta eğitimidir. Derlenen çalışmalar, eczacı müdahalelerinin reçeteleme hatalarını, ilaç uyuşmazlıklarını ve ilaç-ilaç etkileşimlerini azaltabileceğini göstermiştir. Çalışmalar, eczacı tarafından sağlanan hasta danışmanlığı ve eğitiminin KY'de yaşam kalitesini ve hastanın bilgisini arttırabileceğini göstermiştir. Diğer sonuçlarda anlamlı bir fark görülmemiştir. Bu konunun daha da geliştirilmesi için kalp yetersizliğinde eczacı müdahalelerini içeren geniş ölçekli randomize kontrollü çalışmalar ve meta-analizler yapılmalıdır.

Keywords

Eczacı müdahaleleri, farmasötik bakım, kalp yetersizliği, klinik eczacı

References

• 1. McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, J.G.F., Coats, A.J.S., Crespo-Leiro, M.G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A.W., Jaarsma, T., Jankowska, E.A., Lainscak, M., Lam, C.S.P., Lyon, A.R., McMurray, J.J.V., Mebazaa, A., Mindham, R., Muneretto, C., Piepoli, M.F., Price, S., Rosano, G.M.C., Ruschitzka, F., Skibelund, A.K., ESC Scientific Document Group. (2021). Corrigendum to 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC, European Heart Journal, 42(48), 4901. [CrossRef]
• 2. Heidenreich, P.A., Bozkurt, B., Aguilar, D., Allen, L.A., Byun, J.J., Colvin, M.M., Deswal, A., Drazner, M.H., Dunlay, S.M., Evers, L.R., Fang, J.C., Fedson, S.E., Fonarow, G.C., Hayek, S.S., Hernandez, A.F., Khazanie, P., Kittleson, M.M., Lee, C.S., Link, M.S., Milano, C.A., Yancy, C.W. (2022). 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), 895-1032. [CrossRef]
• 3. Groenewegen, A., Rutten, F.H., Mosterd, A., Hoes, A.W. (2020). Epidemiology of heart failure. European journal of heart failure, 22(8), 1342-1356. [CrossRef]
• 4. UpToDate Web site. (2024). Retrieved from https://www.uptodate.com/. Accessed date: 31.07.2024.
• 5. van Riet, E.E., Hoes, A.W., Wagenaar, K.P., Limburg, A., Landman, M.A., Rutten, F.H. (2016). Epidemiology of heart failure: The prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. European Journal of Heart Failure, 18(3), 242-252. [CrossRef]
• 6. Rossignol, P., Hernandez, A.F., Solomon, S.D., Zannad, F. (2019). Heart failure drug treatment. The Lancet, 393(10175), 1034-1044. [CrossRef]
• 7. Tsao, C.W., Lyass, A., Enserro, D., Larson, M.G., Ho, J.E., Kizer, J.R., Gottdiener, J.S., Psaty, B.M., Vasan, R.S. (2018). Temporal trends in the incidence of and mortality associated with heart failure with preserved and reduced ejection fraction. JACC: Heart Failure, 6(8), 678-685. [CrossRef]
• 8. Shah, K.S., Xu, H., Matsouaka, R.A., Bhatt, D.L., Heidenreich, P.A., Hernandez, A.F., Devore, A.D., Yancy, C.W., Fonarow, G.C. (2017). Heart failure with preserved, borderline, and reduced ejection fraction: 5-Year outcomes. Journal of the American College of Cardiology, 70(20), 2476-2486. [CrossRef]
• 9. Doorenbos, A.Z., Levy, W.C., Curtis, J.R., Dougherty, C.M. (2016). An intervention to enhance goals-of-care communication between heart failure patients and heart failure providers. Journal of Pain and Symptom Management, 52(3), 353-360. [CrossRef]
• 10. Braun, L.T., Grady, K.L., Kutner, J.S., Adler, E., Berlinger, N., Boss, R., Butler, J., Enguidanos, S., Friebert, S., Gardner, T.J., Higgins, P., Holloway, R., Konig, M., Meier, D., Morrissey, M.B., Quest, T.E., Wiegand, D.L., Coombs-Lee, B., Fitchett, G., Gupta, C., American Heart Association Advocacy Coordinating Committee. (2016). Palliative care and cardiovascular disease and stroke: A policy statement from the American Heart Association/American Stroke Association. Circulation, 134(11), e198-e225. [CrossRef]
• 11. Arunmanakul, P., Kengkla, K., Chaiyasothi, T., Phrommintikul, A., Ruengorn, C., Permsuwan, U., Thakkinstian, A., Page, R.L., Munger, M.A., Nathisuwan, S., Chaiyakunapruk, N. (2021). Effects of pharmacist interventions on heart failure outcomes: A systematic review and meta-analysis. JACCP: Journal of The American College of Clinical Pharmacy, 4(7), 871-882. [CrossRef]
• 12. Anderson, S.L., Marrs, J.C. (2018). A review of the role of the pharmacist in heart failure transition of care. Advances in Therapy, 35(3), 311-323. [CrossRef]
• 13. Hatah, E., Braund, R., Tordoff, J., Duffull, S.B. (2014). A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. British Journal of Clinical Pharmacology, 77(1), 102-115. [CrossRef]
• 14. Suzuki, M., Matsue, Y., Izumi, S., Kimura, A., Hashimoto, T., Otomo, K., Saito, H., Suzuki, M., Kato, Y., Funakoshi, R. (2018). Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication. Heart and Vessels, 33(6), 615-622. [CrossRef]
• 15. Albekairy, A.M. (2014). Pharmacists’ perceived barriers to patient counseling. Journal of Applied Pharmaceutical Science, 4(1), 70-73.
• 16. Kelly, W.N., Ho, M.J., Bullers, K., Klocksieben, F., Kumar, A. (2021). Association of pharmacist counseling with adherence, 30-day readmission, and mortality: A systematic review and meta-analysis of randomized trials. Journal of the American Pharmacists Association: JAPhA, 61(3), 340-350. [CrossRef]
• 17. World Health Organization (WHO) and International Pharmaceutical Federation (FIP) Web site (2011). Joint FIP/WHO guidelines on good pharmacy practice: Standards for quality of pharmacy services (Report No. 961). Retrieved From https://cdn.who.int/media/docs/default-source/medicines/norms-and-standards/guidelines/distribution/trs961-annex8-fipwhoguidelinesgoodpharmacypractice.pdf. Accessed date: 16.06.2024.
• 18. Okumura, L.M., Rotta, I., Correr, C.J. (2014). Assessment of pharmacist-led patient counseling in randomized controlled trials: A systematic review. International Journal of Clinical Pharmacy, 36(5), 882-891. [CrossRef]
• 19. Salas, C.M., Miyares, M.A. (2015). Implementing a pharmacy resident run transition of care service for heart failure patients: Effect on readmission rates. American Journal of Health-system Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 72(11 Suppl 1), 43-47. [CrossRef]
• 20. Milfred-LaForest, S.K., Gee, J.A., Pugacz, A.M., Piña, I.L., Hoover, D.M., Wenzell, R.C., Felton, A., Guttenberg, E., Ortiz, J. (2017). Heart failure transitions of care: A pharmacist-led post-discharge pilot experience. Progress in Cardiovascular Diseases, 60(2), 249-258. [CrossRef]
• 21. Warden, B.A., Freels, J.P., Furuno, J.P., Mackay, J. (2014). Pharmacy-managed program for providing education and discharge instructions for patients with heart failure. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 71(2), 134-139. [CrossRef]
• 22. Parajuli, D.R., Kourbelis, C., Franzon, J., Newman, P., Mckinnon, R.A., Shakib, S., Whitehead, D., Clark, R.A. (2019). Effectiveness of the pharmacist-involved multidisciplinary management of heart failure to improve hospitalizations and mortality rates in 4630 patients: A systematic review and meta-analysis of randomized controlled trials. Journal of Cardiac Failure, 25(9), 744-756. [CrossRef]
• 23. Moye, P.M., Chu, P.S., Pounds, T., Thurston, M.M. (2018). Impact of a pharmacy team-led intervention program on the readmission rate of elderly patients with heart failure. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 75(4), 183-190. [CrossRef]
• 24. Yassin, H.T., Hiwa, K., Saaed, K.A.O. (2020). Pharmacist collaborative care in heart failure management in Kirkuk City- Iraq. Systematic Reviews Pharmacy, 11(3), 309-319.
• 25. Schulz, M., Griese-Mammen, N., Anker, S.D., Koehler, F., Ihle, P., Ruckes, C., Schumacher, P.M., Trenk, D., Böhm, M., Laufs, U., PHARM-CHF Investigators (2019). Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: Results of the PHARM-CHF randomized controlled trial. European Journal of Heart Failure, 21(8), 1012-1021. [CrossRef]
• 26. Roblek, T., Deticek, A., Leskovar, B., Suskovic, S., Horvat, M., Belic, A., Mrhar, A., Lainscak, M. (2016). Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: A randomized, double-blind, controlled trial. International Journal of Cardiology, 203, 647-652. [CrossRef]
• 27. Vinluan, C.M., Wittman, D., Morisky, D. (2015). Pharmacist discharge counselling in the elderly. Journal of Pharmaceutical Health Services Research, 6, 103-110. [CrossRef]
• 28. Barker, A., Barlis, P., Berlowitz, D., Page, K., Jackson, B., Lim, W.K. (2012). Pharmacist directed home medication reviews in patients with chronic heart failure: A randomised clinical trial. International Journal of Cardiology, 159(2), 139-143. [CrossRef]
• 29. R Lowrie, R., Mair, F.S., Greenlaw, N., Forsyth, P., Jhund, P.S., McConnachie, A., Rae, B., McMurray, J. J., Heart Failure Optimal Outcomes from Pharmacy Study (HOOPS) Investigators (2012). Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. European Heart Journal, 33(3), 314-324. [CrossRef]
• 30. Korajkic, A., Poole, S.G., MacFarlane, L.M., Bergin, P.J., Dooley, M.J. (2011), Impact of a pharmacist intervention on ambulatory patients with heart failure: A randomised controlled study. Journal of Pharmacy Practice and Research, 41,126-131. [CrossRef]
• 31. Eggink, R.N., Lenderink, A.W., Widdershoven, J.W., van den Bemt, P.M. (2010). The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharmacy World & Science: PWS, 32(6), 759-766. [CrossRef]
• 32. McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, J.G.F., Crespo-Leiro, M.G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A.W., Jaarsma, T., Jankowska, E.A., Lainscak, M., Lam, C.S.P., Lyon, A.R., McMurray, J.J.V., Mebazaa, A., Mindham, R., Muneretto, C., Piepoli, M.F., Price, S., Rosano, G.M.C., Ruschitzka, F., Skibelund, A.K., ESC Scientific Document Group. (2023). Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 44(37), 3627-3639. [CrossRef]