Evaluation of a Pharmacist-Driven Aldosterone Antagonist Stewardship Program in Patients With Heart Failure

Abstract

In patients with HFrEF, a pharmacist-driven aldosterone antagonist optimization initiative significantly increased appropriate prescribing and documentation for aldosterone antagonist therapy.

A pharmacist-led heart failure stewardship initiative for guideline-directed medical therapy in hospitalized patients with reduced ejection fraction

“…28 Using our prescriber-alert tool, we observed similar improvements to β-blockers and overall GDMT prescription, as seen in inpatient and outpatient settings using alternative interventions, 27,28 while also observing improvement to MRA prescription that was reported for hospital inpatients. 26,27 Our tool was patient-specific and provided the prescriber an opportunity to consult pharmacy, making the alert more targeted, a strategy that previous HFrEF stewardship programs were also able to successfully use. [26][27][28] In contrast to more resource-intensive initiatives, this stewardship tool can easily be implemented by non-pharmacist health care providers, does not require electronic patient charts to execute and was not found to be time-consuming to implement.…”

“…Interventions for the improvement and optimization of GDMT prescription in patients with HFrEF have shown success in elevating both individual and combined therapy prescription upon hospital discharge 26,27 or at 30-day follow-up for outpatients. 28 Using our prescriber-alert tool, we observed similar improvements to β-blockers and overall GDMT prescription, as seen in inpatient and outpatient settings using alternative interventions, 27,28 while also observing improvement to MRA prescription that was reported for hospital inpatients.…”

“…26,27 Our tool was patient-specific and provided the prescriber an opportunity to consult pharmacy, making the alert more targeted, a strategy that previous HFrEF stewardship programs were also able to successfully use. 26-28 In contrast to more resource-intensive initiatives, this stewardship tool can easily be implemented by non-pharmacist health care providers, does not require electronic patient charts to execute and was not found to be time-consuming to implement. We believe part of the success of this stewardship tool was due to the fact it was reviewed by cardiology peers with feedback incorporated prior to implementation of the tool and was designed in a way that allowed for physicians to maintain their prescribing autonomy by simply “nudging” the prescribers.…”

Economic Impact of Ambulatory Clinical Pharmacists in an Advanced Heart Failure Clinic

“…Evidence suggests pharmacist-led medication optimization in HF has improved medication adherence and guidelinedirected medical therapy (GDMT) as well as decreased hospitalization rates for HF. [3][4][5][6][7][8] In addition to improvements in clinical outcomes, a recent prospective observational study has demonstrated an annual total savings of $830,748 ($149,566 from clinical interventions and $681,182 from patient direct out-of-pocket expense reduction) with the addition of a cardiology clinical pharmacy specialist in a preventive cardiology practice. 9 Thus, pharmacists are integral to optimizing population health through better patient management and allocation of resources.…”