Pharmacy‐based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM‐CHF randomized controlled trial

Abstract

Aims Medication non‐adherence is frequent and is associated with high morbidity and mortality in patients with chronic heart failure (CHF). We investigated whether an interdisciplinary intervention improves adherence in elderly CHF patients. Methods and results The study population (mean age 74 years, 62% male, mean left ventricular ejection fraction 47%, 52% in New York Heart Association class III) consisted of 110 patients randomized into the pharmacy care and 127 into the usual care group. The median follow‐up was 2.0 years (interquartile range 1.2–2.7). The pharmacy care group received a medication review followed by regular dose dispensing and counselling. Control patients received usual care. The primary endpoint was medication adherence as proportion of days covered (PDC) within 365 days for three classes of heart failure medications (beta‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists). The main secondary outcome was the proportion of adherent patients (PDC ≥ 80%). The primary safety endpoint was days lost due to unplanned cardiovascular hospitalizations (blindly adjudicated) or death. Pharmacy care compared with usual care resulted in an absolute increase in mean adherence to three heart failure medications for 365 days [adjusted difference 5.7%, 95% confidence interval (CI) 1.6–9.8, P = 0.007]. The proportion of patients classified as adherent increased (odds ratio 2.9, 95% CI 1.4–5.9, P = 0.005). Pharmacy care improved quality of life after 2 years (adjusted difference in Minnesota Living with Heart Failure Questionnaire scores −7.8 points (−14.5 to −1.1; P = 0.02), compared to usual care. Pharmacy care did not affect the safety endpoints of hospitalizations or deaths. Conclusion Pharmacy care safely improved adherence to heart failure medications and quality of life.

Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

“…Critical appraisal and reduction of co-medication may also be beneficial. In addition, pharmacy care improves adherence to HF medications and quality of life, which was recently demonstrated by the PHARM-CHF investigators [30].…”

August 2019 at a glance: arrhythmogenic cardiomyopathy, biomarkers of inflammation, insulin treatment, initiation of sacubitril/valsartan, and pharmacy‐based intervention to increase medication adherence

“…Pharmacy care also improved quality of life after 2 years. It did not affect the safety endpoints of hospitalizations or deaths …”

Heart Failure Association of the European Society of Cardiology Quality of Care Centres Programme: design and accreditation document

“…The close engagement of family members and social support networks is also required . Randomized trials comparing usual care with multidisciplinary care of HF patients have demonstrated the benefits of primary care follow‐up, nurse home visits, telemonitoring and pharmacy‐based interventions . In addition, a recent network meta‐analysis, including 53 randomized trials (12 356 patients), confirmed that multidisciplinary management can significantly decrease the risks for mortality and HF hospitalization .…”