Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication

Abstract

We evaluated the impact of pharmacist-led heart failure (HF) drug recommendations during hospitalization for hospitalized patients with HF. Hospitalized patients with HF were retrospectively reviewed. Patients were hospitalized before (n = 208, non-intervention group) or after (n = 170, intervention group) the launch of the HF multidisciplinary team (HFMDT) approach with pharmacist-led HF medication optimization. There were no significant group differences in patient background characteristics at admission. Patients with HF with reduced ejection fraction who were not on beta blockers or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACE-I/ARB) at admission were significantly more likely to be on beta blockers at the time of discharge in the intervention group (73.3 vs 96.3%, P = 0.027) compared to those in non-intervention group; however, the change in ACE-I/ARB prescriptions was not significant (53.3 vs 63.3%, P = 0.601). The proportion of patients on any drug with recommendations against its use in patients with HF did not change from admission to discharge in the non-intervention group (21.2 vs. 20.2%, P = 0.855), but was significantly reduced in the intervention group (22.9 vs. 12.9%, P = 0.005). There were no group differences in the in-hospital all-cause mortality (non-intervention, 3.4%; intervention, 2.4%; P = 0.761) or length of hospital stay (median: non-intervention, 13 days; intervention, 14 days; P = 0.508). Pharmacist-led HF drug recommendations during hospitalization as part of a HFMDT approach for hospitalized patients with HF can increase beta blocker prescriptions and decrease non-preferred drug prescriptions.

Evaluation of demographic, clinical characteristics, and the prescribing practice of guideline-directed medical therapy among chronic heart failure outpatients in multidisciplinary clinics in a large tertiary hospital: a retrospective audit of 1186 patients from 12 years

“…Importantly, the prescription of ACEIs/ARBs, β-blockers and MRA in current study were similar or even superior than to previous studies conducted in Australia in HFrEF patients [33,37]. However,, higher prescription rate for ACEIs/ARBs and β-blockers have been reported in studies conducted in the USA [38] and Europe than in our ndings [24].…”

Prognostic Impact of the Preservation of Activities of Daily Living on Post-Discharge Outcomes in Patients With Acute Heart Failure

“…Finally, other approaches, such as educational programs and guideline-based therapy to improve HF prognosis, could contribute to preservation of the ability to perform ADL. 31,32 Taken together, we should recognize the importance of a multidisciplinary team approach to preserving HF patients' ability to perform ADL.…”

Developing Multidisciplinary Management of Heart Failure in the Super-Aging Society of Japan

“…52 In Japan, Suzuki et al reported that pharmacist-led HF drug recommendations during hospitalization as part of a multidisciplinary team approach for hospitalized patients with HF could increase β-blocker prescriptions and decrease non-preferred drug prescriptions. 53 Moreover, pharmacists' involvement in palliative care is rapidly increasing in Japan. According to the Japanese nationwide questionnaire on palliative care in patients with HF, dyspnea, pain, anxiety, delirium, and general fatigue are common in patients with endstage HF.…”

“…Nutritional management of patients with HF and malnutrition50,51 Nutritional counseling50,51 Nutritional support team should collaborate with the HF teamPharmacistsPatient education to improve medication adherence53 Prevention of adverse drug reactions Suggestion of medications for palliative care and delirium54 Medical social worker Assessment of social support and providing assistance Discharge planning56 …”