Summary

A new review shows that pharmacists play a very useful role in managing heart failure. Their involvement reduces the risk of hospitalization which both improves patient quality of life and reduces the public health burden of heart failure.

Introduction

Increased survival following heart attack and an aging population are both contributing to a higher rate of heart failure. Although treatments have advanced in recent years, it has to be admitted that a diagnosis of heart failure still carries a poor prognosis. Within a year of diagnosis, up to 50 percent of heart failure patients will be re-hospitalized and around 40 percent will die.

Medications for heart failure include angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. The problem is that these are under-used. A multi-disciplinary approach, including input from a pharmacist, could perhaps improve outcomes for the patient with heart failure. Researchers at the University of Alberta, Edmonton, Canada, have looked back at research on heart failure that has involved input from a pharmacist.

What was done

The researchers found 12 studies covering over 2,000 patients with heart failure where care given by a pharmacist was compared with usual care. In seven studies, the pharmacist was the key person, helping with medication, education, adherence, and communication with the physician. In other studies, the pharmacist was part of a team looking after the patient with heart failure. The team analyzed whether involvement of the pharmacist reduced mortality and hospitalization for both all causes and for heart failure.

What was found

There was no overall reduction in mortality with pharmacist intervention. But there was a significant reduction in hospitalization rates, by around one third, both overall and for heart failure if the pharmacist was involved.

What this study means

Heart failure is one of the leading causes of hospitalization, accounting for one million or so cases each year in the United States, and this is likely to increase. These hospitalizations are, the researchers say, too often attributed to problems with medication. Therefore, more input from the pharmacist, who is the one who knows most about medication, might be expected to decrease the risk of hospitalization.

This was found to be so, but it might seem disappointing that despite this there was no decrease in overall mortality. The researchers say this was likely because the sample size and time of follow up were both too small.

It is also not clear from the current study what kind of pharmacist intervention makes the most difference when it comes to looking after patients with heart failure. But the finding that their work can reduce hospitalizations by one third underlines the key role medication plays in managing heart failure. Therefore, a pharmacist should always be involved in caring for the patient with heart failure.

Source

Pharmacist Care of Patients with Heart Failure
SL. Koshman, TL. Charrois,  et al., Arch Intern Med, April 14 2008, vol. 168, pp. 687--694

Links

• An Overview of Congested Heart Failure