Clinical Pharmacy Services in Heart Failure: An Opinion Paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network

Abstract

Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by clinical pharmacists, to recommend minimum training for clinical pharmacists engaged in HF care, and to suggest financial strategies to support clinical pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with clinical pharmacist activities support the value of making this resource available to HF teams.

Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

“…18 The impact of clinical pharmacist participation in chronic diseases management programmes has been proven. 19 However, a 2009 ACC survey demonstrated that many cardiologists are unfamiliar with the application of a healthcare team approach to patient care including clinical pharmacists. 20 Unfortunately, the role of clinical pharmacists in managing acute coronary syndrome patients is still underutilized.…”

Readmissions and clinical outcomes in heart failure patients: A retrospective study

“…23 Recent studies reiterate positive HF outcomes by pharmacist interventions in reducing emergency department visits, and all-cause readmissions. 24…”

Integrating New Pharmacologic Agents into Heart Failure Care: Role of Heart Failure Practice Guidelines in Meeting This Challenge

“…[59][60][61] A number of recent publications provide additional insights on the positive impact pharmacists have in the management of HF. [62][63][64] One group 63 reviewed the importance of clinical pharmacists on multidisciplinary teams for inpatient, outpatient, and transplant management of patients with HF. They found that pharmacists improve the care of patients with HF by not only improving adherence to performance measures and evidence-based drug therapies, decreasing readmission rates, and assessing and providing solutions for barriers to medication access, but also through supplementation of activities of the other team members through disbursement of patient education on medication-related topics.…”