Impact of Pharmacist Involvement in Heart Failure Transition of Care

Abstract

Background: Heart failure (HF) transition of care (TOC) programs may improve continuity of care and coordination and decrease hospital readmissions. Objective: This study evaluated the impact of pharmacy-led HF TOC on HF readmission rate. Methods: This was a single-center, pre-post quasi-experimental study. Pharmacy TOC comprised admission and discharge medication reconciliations and patient education. Patients were included if they had a primary HF diagnosis. Patients were excluded if they were admitted for a non-HF diagnosis, admitted for <24 hours, had a stage IV cancer or dementia diagnosis, or were transferred to hospice care. The primary outcome was HF 30-day readmission rate. Results: A total of 663 patients were included in the study: 330 in the control group and 333 in the intervention group. The average age for both groups was 67 ± 16 years; 48.1% were female; 56.9% were African American; and 51.4% of patients had an ejection fraction ≤40%. In the control group, 57 (17.3%) patients had a HF 30-day readmission compared with 35 (10.5%) patients in the intervention group. After adjusting for age, the intervention group continued to show a difference in readmission (odds ratio = 0.578; 95% CI = 0.367-0.911; P = 0.018). The most common interventions were medication addition (11%), dose titration (7.5%), medication discontinuation (6.6%), and duplication avoidance (2.7%). Conclusion and Relevance: Pharmacy-led HF TOC, as a component of a targeted hospital-based initiative, significantly decreased HF 30-day readmission rate. Results from this study warrant further research to explore which interventions in TOC are most effective.

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

“…All studies conducted transitional care interventions for patients with HF. Regarding research design, there were 10 RCTs [16,21,22,24,28,29,32,33,36,38], two quasi-experiments [23,40], two pre-and post-tests [17,26], six cohort studies [18,19,27,34,35,37], and five prospective studies [20,25,30,31,39]. Although it was necessary to establish controls to verify the effects of transitional care interventions, in six of the 25 studies [17][18][19][20]26,39], there was no comparative control group set up to verify the effectiveness of transitional care interventions.…”

“…A multidisciplinary team served as the primary intervention provider in five studies [17,31,35,36,39]. In the remaining five studies [18,19,27,34,40], the major intervention providers were pharmacists or pharmacy students.…”

“…Five of the 25 studies frequently conducted transitional care interventions for 3 months [20,22,25,28,36]. Of the 25 studies, four were conducted for 2 weeks [18,21,24,31], four for 4 weeks [17,30,37,40], and three for 6 months [29,33,38].…”

“…Subjects presented with various HF types: two studies reported on end-stage HF [28,32], three on chronic HF [16,23,33], two on congestive HF [21,37], one on decompensated HF [29], and the remaining 17 on HF [17][18][19][20]22,[24][25][26][27]30,31,[34][35][36][38][39][40]. To identify HF severity, we considered the New York Heart Association (NYHA) class and left ventricle ejection fraction (LVEF).…”

“…To identify HF severity, we considered the New York Heart Association (NYHA) class and left ventricle ejection fraction (LVEF). Only 10 of the 25 studies reported NYHA class or LVEF [16,19,21,22,24,28,29,34,36,40]. One study reported B-type natriuretic peptide level >200 ng/mL [25], and two studies reported HF with reduced or preserved ejection fraction [17,18].…”