Heart failure (HF) patients tend to have multiple comorbidities resulting in complex therapy regimens and medication adherence issues. Nevertheless, the evidence of pharmacists' contributions to improving clinical outcomes in HF is limited. To assess the impact of pharmacist intervention on all‐cause hospitalization, mortality, and quality of life (QoL) in HF) patients. A systematic search of PubMed, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and CINAHL was performed up to April 30, 2020. Randomized controlled trials (RCTs) evaluating pharmacist interventions compared with usual care in adult HF patients were selected. Data were extracted independently by two authors. Random effects meta‐analysis models were used to pool treatment effects and confidence intervals (CIs). Twenty‐nine trials identified 6965 predominantly HF with reduced ejection fraction (HFrEF) patients. The average age was 72.0 years (interquartile range [IQR] 66.0‐76.0) and 48% were men (IQR 40.0%‐68.0%). The majority were New York Heart Association (NYHA) Functional class (FC) II‐III with median left ventricular ejection fraction (LVEF) of 38.5% (IQR 34.5%‐49.5%). Pharmacist interventions were associated with a significant reduction of all‐cause mortality (risk ratio [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). A significant increase in the 36‐item Short form Health survey (SF‐36) on role physical (Mean deviation [MD], 8.5; 95% CI, 1.00 to 16.01, P = 0.026) and mental health (MD, 7.49; 95% CI, 3.88 to 11.10, P < 0.001) were observed. In addition, a significant improvement in Minnesota Living with Heart Failure Questionnaire score was observed (MD ‐3.55; 95% CI ‐6.28 to −0.82; P = 0.01). Pharmacist interventions in patients with HF significantly reduced all‐cause mortality and hospitalizations and improved QoL. Integration of a pharmacist into a HF care team or care pathway should be strongly considered as an important element of a multidisciplinary team.
Background:
Currently, there is a lack of information on the comparative efficacy and safety of non-statin lipid-lowering agents (NST) in cardiovascular (CV) disease risk reduction when added to background statin therapy (ST). This study determine the relative treatment effects of NST on fatal and non-fatal CV events among statin-treated patients.
Methods:
A network meta-analysis based on a systematic review of randomized controlled trials (RCTs) comparing non-statin lipid-modifying agents among statin-treated patients was performed. PubMed, EMBASE, CENTRAL, and Clinicaltrial.gov were searched up to April 10, 2018. The primary outcomes were CV and all-cause mortalities. Secondary CV outcomes were coronary heart disease (CHD) death, non-fatal myocardial infarction (MI), any stroke, and coronary revascularization. Risks of discontinuations were secondary safety outcomes.
Results:
Sixty-seven RCTs including 259,429 participants with eight interventions were analyzed. No intervention had significant effects on the primary outcomes (CV mortality and all-cause mortality). For secondary endpoints, proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK) plus statin (PCSK/ST) significantly reduced the risk of non-fatal MI (RR 0.82, 95% CI 0.72–0.93,
p
= 0.003), stroke (RR 0.74, 95% CI 0.65–0.85,
p
< 0.001), coronary revascularization (RR 0.84, 95% CI 0.75–0.94,
p
= 0.003) compared to ST. Combinations of ST and all NST except PCSK and ezetimibe showed higher rate of discontinuation due to adverse events compared to ST.
Conclusions:
None of NST significantly reduced CV or all-cause death when added to ST. PCSKs and to a lesser extent, ezetimibe may help reduce cardiovascular events with acceptable tolerability profile among broad range of patients.
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