The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

Schumacher, Pia M.; Becker, Nicolas; Tsuyuki, Ross T.; Griese‐Mammen, Nina; Koshman, Sheri L.; McDonald, Michael; Bouvy, Marcel L.; Rutten, Frans H.; Laufs, Ulrich; Böhm, Michael; Schulz, Martin

doi:10.1002/ehf2.13508

Cited by 28 publications

(23 citation statements)

References 54 publications

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“…12 A systematic review reported that pharmacists' interventions improved patients' adherence. [26][27][28] Furthermore, a systematic review of 29 studies that used text messages to improve adherence found efficacy in interventions that used motivational messages. 29 Therefore, for Asian patients, more aggressive interventions are needed by pharmacists for preoperative discontinuation of medications.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

Akamine¹,

Nagasaki²,

Tomizawa³

et al. 2022

PPA

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Data on risk factors for non-adherence to doctors' and pharmacists' instructions to discontinue medications prior to surgery are lacking. This study aimed to identify characteristics and risk factors for such non-adherent patients. Patients and Methods: Data (including patient age, sex, prescription medications, comorbidities, presence of roommate at home, and number of days between receiving instruction and surgery) of 887 patients who used medications affecting surgery at a university hospital from April 2017 to March 2020 were retrospectively evaluated. The primary endpoint was to investigate the rate of non-adherence and to explore independent risk factors for non-adherence (with age categorized as ≥65 [versus <65] years). Secondary endpoints included analysis of limited number of departments subgroup and a sensitivity analysis (with age categorized as ≥75 [versus <75] years) to confirm the robustness of the primary endpoint results. Independent risk factors for non-adherence were identified using logistic regression analysis. Results:The non-adherence rate was 11.4% (n=101/887), median age (interquartile range) at admission was 73 (70-79) years, and proportion of male patients was 81.2% (n=82). The main analysis adjusted for age ≥65 (versus <65) years showed age as a risk factor for increased nonadherence (adjusted odds ratio: 2.1, 95% confidence interval: 1.09-4.05; p=0.027). However, analyses adjusted for departments (other than urology, gynecology, and breast surgery, with a large sex bias in hospitalized patients) and for age ≥75 (versus <75) years showed no such risk. Conclusion: Age ≥65 years was associated with a higher risk of non-adherence to medications that should be discontinued before surgery. It is important for doctors and pharmacists to ensure that patients at high risk for non-adherence are aware of the importance of adherence. Our findings may help identify patients at high risk for non-adherence to such medications.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

Akamine¹,

Nagasaki²,

Tomizawa³

et al. 2022

PPA

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“…Moreover, these pharmacist interventions also improved quality of life evaluated by using the 36‐Item Short Form Survey (SF‐36) for the domain of mental health and vitality (2 meta‐analyses) 8 . Another meta‐analysis focusing on outpatient chronic heart failure showed that pharmacist intervention using patient education and pharmaceutical care technique significantly reduced the total score of SF‐36, as well 34 . Table 2 presents the description of all included unique meta‐analyses.…”

Section: Resultsmentioning

confidence: 99%

“…These outcomes were medication adherence (2 meta-analyses), 7,30 blood pressure (20 meta-analyses), 6,15,16,20,22,23,28,32 plasma glucose and glycated haemoglobin level (20 meta-analyses), 6,16,17,19,[26][27][28][29]31,33 cholesterol level (16 meta-analyses), 6,21,25,31 body mass index (1 meta-analysis), 21 CV risk score (1 meta-analysis) 35 and smoking (2 meta-analyses). 18,20 In addition, there were 16 8,34 and 7 24 meta-analyses comparing pharmacist intervention vs. usual care in heart failure and anticoagulation therapy management. The summary of examined outcomes are depicted in Figure 1.…”

Section: Description and Summary Of Meta-analysesmentioning

confidence: 99%

Effects of pharmacist interventions on cardiovascular risk factors and outcomes: An umbrella review of meta‐analysis of randomized controlled trials

Rattanavipanon

Chaiyasothi

Puchsaka

et al. 2022

Brit J Clinical Pharma

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Aims To grade the evidence from published meta‐analyses of randomized controlled trials (RCTs) that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes. Methods MEDLINE, Embase, and the Cochrane Library were searched from database inception to July 2021. Meta‐analyses of RCTs were eligible. Quality of evidence were assessed by GRADE approach. Results From 9308 publications, 149 full‐text articles were evaluated for eligibility, and 24 studies with 85 unique meta‐analyses that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes were selected. Overall, 71.7% (61/85) of unique meta‐analyses showed significant impacts of pharmacist intervention. For the quality of evidence, 63.4% of meta‐analyses had large heterogeneity (I2 > 50%) while 1.2, 16.5, 32.9 and 49.4% of meta‐analyses were graded as high, moderate, low and very low quality based on GRADE approach, respectively. Among meta‐analyses with moderate quality, pharmacist interventions significantly mitigated risk factors (including 6/3 mmHg reduction of blood pressure, increased the rate of lipid control, glucose control and smoking cessation (pooled odds ratio, [95% confidence interval] 1.91 [1.55, 2.35], 3.11 [2.3, 4.3] and 2.3 [1.33, 3.97], respectively) and improved medication adherence (1.67 [1.38, 2.02]). Furthermore, pharmacist interventions significantly reduced all‐cause mortality (0.72 [0.58, 0.89]) and improved quality of life in patients suffering from chronic heart failure. Conclusion This umbrella review found convincing evidence that pharmacist intervention can provide a wide range of benefits in cardiovascular disease management, ranging from risk factor control, improvement in medication adherence and, in some settings, reduction in morbidity and mortality.

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“…Moreover, pharmacist care and nurse practitioner education have been reported to improve knowledge of heart failure and clinical outcomes in patients with heart failure. 34,35 The association between the accuracy of patient-reported comorbidities and patient prognosis may also be a result of the association between the number of comorbidities and prognosis. In this study, the results were consistent even after adjusting for several confounders.…”

Section: Discussionmentioning

confidence: 99%

Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure

et al. 2022

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Aims A patient's understanding of his or her own comorbidities is part of the recommended patient education for those with heart failure. The accuracy of patients' understanding of their comorbidities and its prognostic impact have not been reported. Methods and resultsPatients hospitalized for heart failure (n = 1234) aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) completed a questionnaire regarding their diagnoses of diabetes, malignancy, stroke, hypertension, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD). The patients were categorized into three groups based on the number of agreements between self-reported comorbidities and provider-reported comorbidities: low (1-2, n = 19); fair (3-4, n = 376); and high (5-6, n = 839) agreement groups. The primary outcome was a composite of all-cause mortality or heart failure rehospitalization at 1 year. The low agreement group had more comorbidities and a higher prevalence of a history of heart failure. The agreement was good for diabetes (κ = 0.73), moderate for malignancy (κ = 0.56) and stroke (κ = 0.50), and poor-to-fair for hypertension (κ = 0.33), COPD (κ = 0.25), and CAD (κ = 0.30). The fair and low agreement groups had poorer outcomes than the good agreement group [fair agreement group: hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.01-1.56; P = 0.041; low agreement group: HR: 2.74: 95% CI: 1.40-5.35; P = 0.003]. Conclusions The ability to recognize their own comorbidities among older patients with heart failure was low. Patients with less accurate recognition of their comorbidities may be at higher risk for a composite of all-cause mortality or heart failure rehospitalization.

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The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

Cited by 28 publications

References 54 publications

Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

Effects of pharmacist interventions on cardiovascular risk factors and outcomes: An umbrella review of meta‐analysis of randomized controlled trials

Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure

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