The impact of pharmacist/physician care on quality of life in elderly heart failure patients: results of the PHARM‐CHF randomized controlled trial

Abstract

Aims Patients with heart failure (HF) have impaired quality of life (QoL). The randomized controlled trial PHARM-CHF investigated whether an interdisciplinary intervention consisting of regular contacts with the community pharmacy and weekly dosing aids improves medication adherence in patients with HF. It is unknown how an intervention involving frequent structured pharmacy visits affects QoL. Our aim was to explore adherence to the intervention and effects on QoL. Methods and results Among 237 patients, n = 110 were randomized to pharmacy care and n = 127 to usual care. The pharmacy care group received a medication review followed by (bi-)weekly dose dispensing and counselling. The median follow-up was 2.0 years [inter-quartile range (IQR) 1.2-2.7]. Median interval between pharmacy visits was 8.4 days (IQR 8.0-10.3) and the visits lasted in median 14 min (IQR 10-15). Median adherence to the intervention was 96% (IQR 84-100). QoL at 365 days was predefined as a main secondary and at 730 days as another secondary endpoint in PHARM-CHF. QoL was measured by the Minnesota Living with Heart Failure Questionnaire; and for 111 patients (n = 47 in the pharmacy care group and n = 64 in the usual care group), data were available at baseline, and after 365 and 730 days (mean age 74 years; 41% female). Improvement in QoL was numerically higher in the pharmacy care group after 365 days and was significantly better after 730 days (difference in total scores À7.7 points [À14.5 to À1.0]; P = 0.026) compared to the usual care group. In all subgroups examined, this treatment effect was preserved. Improvements in the physical and emotional dimensions were numerically higher in the pharmacy care group after 365 days and were significantly better after 730 days: À4.0 points [À6.9 to À1.2]; P = 0.006, and À1.9 points [À3.7 to À0.1]; P = 0.039, respectively. Conclusions A pharmacy-based interdisciplinary intervention was well received by the patients and suggests clinically important improvements in QoL.

Clinical Pharmacist Led-Educational Intervention to Promote Medications' Adherence for Sudanese Patients with Heart Failure: A Prospective Study

“…Although poor medication adherence represents a major problem, however, it also provides a major opportunity to improve outcomes in patients with HF [12]. It was found that, regardless of the assessment tool used or population studied, adherence rates are consistently suboptimal worldwide despite advances in HF management.…”

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

“…As pharmacists’ roles progress to incorporate prescribing, their impact will need to be reassessed. Like other studies of interventions for patients with chronic conditions (e.g., heart failure, hypertension, asthma) [ 82 , 83 , 84 ], this systematic review also highlights that pharmacist-led case management has a positive impact on a patients’ health-related quality of life (HRQoL) and satisfaction with pharmaceutical care.…”

Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF)

“…To the best of our knowledge, this is the first study reporting impact of pharmacist-led-HMTC on quality of life which is an important goal of the treating HF and objectively assessing patient adherence to disease state management including medication adherence in veteran patients. A randomized control multicenter trial PHARM-CHF evaluating impact of involvement of community pharmacist on medication adherence and QOL in 258 HF patients, showed significant improvement in the primary endpoint of medication adherence within 365 days in the pharmacy group compared to usual care group [mean difference 5.7%; (1.6 to 9.8; p = 0.007)] [ 32 ]. Additionally, pharmacy care which included medication counseling and review also improved quality of life after 2 years as evaluated by Minnesota Living with Heart Failure Questionnaire scores [mean difference −7.8 (−14.5 to −1.1; p = 0.02)].…”