Pharmacist-led heart failure clinic improves outcomes for patients

Abstract

Pharmacists are well aware of their value as health care providers, and a new study proves this to be the case when pharmacists are involved with the care of patients with heart failure. The study, published in the Journal of Cardiac Failure by Attar and colleagues, showed the benefit of a pharmacist-led heart failure clinic compared with a standard cardiologist-led clinic for a specific set of patients: those with heart failure and reduced ejection fraction (HFrEF). The heart failure clinic staffed by pharmacists in this prospective, quasi-experimental study focused on optimizing ACEI/ARB, beta-blocker, and aldosterone antagonist dosages. Using guideline-directed medical therapy, pharmacists titrated these drugs to their maximally tolerated dose within the ranges necessary for best outcomes. The evaluation time frame was a 3-month period after an initial visit. The researchers compared an experimental group with usual care—meeting with a cardiologist. Compared with cardiologists, pharmacists had more of their patients at the target dose of appropriate medications by 3 months and met with their patients 2 weeks earlier after hospital discharge. Pharmacists also provided more heart failure education. The study results were statistically significant, despite the small sample sizes. According to lead study author Dana Attar, PharmD, of Henry Ford Health System in Detroit, there was a lot more patient interaction, patient education on limiting fluid and sodium intake, and adjustments to medication regimens during the study time period in the pharmacist group. In addition, there were documented efforts to transition patients to sacubitril/valsartan, based on guideline recommendations, she said. “These findings support the presence of pharmacists in heart failure clinics and emphasize the importance of our role in improving patient care,” said Attar. She added that studies such as this support a practical approach to rapidly achieving optimal goal dose mean time in patients at high risk for heart failure. Thirty-nine patients were included in the pharmacist group, and 35 patients were in the cardiologist group. On average, after a hospital discharge, patients met with a pharmacist within 15 days and a cardiologist within 31 days. A total of 59% of patients in the pharmacist group, compared with 11.4% in the cardiologist group, were at target medication doses by the end of the 3-month study period. Because patients were seen by their pharmacist more frequently, they were more likely to receive heart failure education. These results illustrate the value—both clinically and economically—of having pharmacists more involved in providing outpatient care. Patients receive better, faster, and less-expensive care while freeing up cardiologists’ time to focus on care that only they can provide. The short-term nature of this study is one of its limitations, however. “We are addressing this limitation by doing a follow-up study that will follow patients for a longer time period and is focused on both medication titration effectiveness and outcomes,” said Attar. “The next steps of the study are to investigate long-term outcomes in patients with HFrEF using matched cohorts.” She added that she hopes to be able to integrate their findings across other clinics beyond cardiology within the Henry Ford Health System. Time and again, pharmacist-led clinics have been shown to provide optimal patient care at a lower cost and faster rate than traditional care options. “These findings are consistent and reliable within the context of what we already know,” said Attar. “Previously published studies have also shown that pharmacist-managed heart failure titration clinics achieved target doses of medications at higher percentages compared to usual care.” However, without being recognized as formal health care providers, pharmacists are hamstrung by being unable to bill for their services without using complicated collaborative practice agreements or other workarounds. This study represents a pointed argument to the value of pharmacist-led and guideline-directed care.