Pharmaceutical care of patients with heart failure

Abstract

AimThe aim of this study was to investigate the impact of a pharmacist-led pharmaceutical care programme, involving optimization of drug treatment and intensive education and self-monitoring of patients with heart failure (HF) within the United Arab Emirates (UAE), on a range of clinical and humanistic outcome measures. MethodsThe study was a randomized, controlled, longitudinal, prospective clinical trial at Al-Ain Hospital, Al-Ain, UAE. Patients were recruited from the general medical wards and from cardiology and medical outpatient clinics. HF patients who fulfilled the entrance criteria, and had no exclusion criteria present, were identified for inclusion in the study. After recruitment, patients were randomly assigned to one of two groups: intervention group or control group. Intervention patients received a structured pharmaceutical care service while control patients received traditional services. Patient follow-up took place when patients attended scheduled outpatient clinics (every 3 months). A total of 104 patients in each group completed the trial (12 months). The patients were generally suffering from mild to moderate HF (NYHA Class 1, 29.5%; Class 2, 50.5%; Class 3, 16%; and Class 4, 4%). ResultsOver the study period, intervention patients showed significant ( P < 0.05) improvements in a range of summary outcome measures [AUC (95% confidence limits)] including exercise tolerance [2-min walk test: 1607.2 (1474.9, 1739.5) m·month in intervention patients vs . 1403.3 (1256.5, 1549.8) in control patients], forced vital capacity [31.6 (30.8, 32.4) l·month in the intervention patients vs . 27.8 (26.8, 28.9) in control patients], health-related quality of life, as measured by the Minnesota living with heart failure questionnaire [463.5 (433.2, 493.9) unit·month in intervention patients vs . 637.5 (597.2, 677.7) in control patients; a lower score in this measure indicates better health-related quality of life]. The number of individual patients who reported adherence to prescribed medications was higher ( P < 0.05) in the intervention group (85 vs . 35), as was adherence to lifestyle advice (75 vs . 29) at the final assessment (12 months). There was a tendency to have a higher incidence of casualty department visits by intervention patients, but a lower rate of hospitalization. ConclusionsThe research provides clear evidence that the delivery of pharmaceutical care to patients with HF can lead to significant clinical and humanistic benefits.A. Sadik et al. 18460 :2 Br J Clin Pharmacol

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

“…Randomized controlled studies have shown that pharmacists improve medication and lifestyle adherence as part of a multidisciplinary team. [36][37][38][39][40] Some of these studies also demonstrated improvements in patients' clinical outcomes. 36,37,[39][40][41] Studies Assessing Medication Adherence A summary of studies evaluating pharmacist interventions on medication adherence is presented in Table 3.…”

“…Though not powered to detect, the composite endpoint of all-cause mortality, hospital admissions, and ED visits was not significantly different between the 2 groups (intervention 60%, control 67%, HR = 0.85, 95% CI = 0.55-1.40). Sadik et al (2005) assessed structured pharmaceutical care versus traditional care in 208 HF patients in the United Arab Emirates. 36 The intervention integrated a treatment algorithm, patient education, and self-monitoring through diary cards.…”

“…Sadik et al (2005) assessed structured pharmaceutical care versus traditional care in 208 HF patients in the United Arab Emirates. 36 The intervention integrated a treatment algorithm, patient education, and self-monitoring through diary cards. …”

“…36,37,[39][40][41] Studies Assessing Medication Adherence A summary of studies evaluating pharmacist interventions on medication adherence is presented in Table 3. [36][37][38][39][40][41][42][43][44] One of the earliest randomized controlled trials that assessed the effect of intensive pharmacist counseling randomized 100 elderly patients with stable HF in the United Kingdom to a 3-month pharmacist counseling intervention versus standard care. 40 Medication adherence, per pill count, was 93% for the intervention group and 51% for the control group post-intervention (P < 0.001).…”

Association of increased emergency rooms costs for patients without access to necessary medications

“…This has manifested as improved control of chronic diseases, improvements in adherence, reduced medication spend per patient, and diminished hospital costs. [42][43][44] These findings have led to renewed calls for in-person pharmacist counseling and follow-up to improve medication taking behavior. 45 Related to these study findings, the next steps may involve: 1) Pharmacist follow-up to ensure patients are contacted when they have a medication on record that they have not picked up, coupled with patient education of the importance of taking it as directed.…”