Cardiology Pharmacists Can Optimize, Educate Patients With Heart Failure

This American Heart Month, Irina Sheyko, PharmD, a board-certified cardiology pharmacist with Allegheny Health Network, joins Pharmacy Times to discuss the Network’s outpatient heart failure optimization clinic, which allows cardiology pharmacists to manage and connect with patients to improve outcomes and optimize care. Sheyko dives into disparities between use of referrals between men and women who visit the clinic, the importance of collaboration, and the many advantages of specialized pharmacists’ services.

PT Staff: What is AHN’s outpatient heart failure optimization clinic?

Irina Sheyko, PharmD: This clinic started at Allegheny Health Network about 2 years ago. And what that is, so we call it pomoic— so it's a pharmacist, medication, optimization and education clinic. So where we actually work with the patients and educate them on their disease state as well as manage their medications so that we can optimize their therapy, not only just therapy in general, but as well as the doses to get them to the target doses.

PT Staff: Can you define the cardiology pharmacist? What are the cardiology pharmacist’s core responsibilities at the clinic- what is the cardiology pharmacist’s role as part of a patient’s total care team?

Irina Sheyko, PharmD: The cardiology pharmacists, in general, they are specializing on a focused patient population, or to make sure that patients that have cardiovascular diseases receive effective and save medications, specifically for their cardiovascular diseases. So in general we focus on these patients and we specialize in these patients.

Now in terms of the clinic itself, we focus on patient assessment. It could be like their physical exacerbations of heart failure symptoms, but it could also be assessing their adherence, assessing the barriers to medication adherence, [and] it could also be assessing their health literacy. And then we look at managing medications. So how can we optimize medications, basically allowing more frequent monitoring of these patients. And in addition to all that, we're also providing patient education so that they are educated about their disease state and their medications that are taking and why they're taking them.

PT Staff: What services/resources do you and your clinic have which makes it different from what a cardiologist’s office? Or [even different than what] other pharmacies have alone, without specialists such as yourself?

Irina Sheyko, PharmD: Now, the benefits that the pharmacists have [is] they have in-depth knowledge of these medications that they can identify, maybe side effects or identifying more optimal choice of the medication based on the patient's comorbid conditions.

Also, the success or the advantage is that the pharmacist has a little bit more time to spend with the patients— they can close that gap by having a more access to a health care provider, rather than the maybe the patients wait for a provider to be seen post-discharge.

We also have some knowledge on patient affordability programs and coupons and other maybe funds and things like that and can enrolled patients when they would be eligible, when maybe other providers either don't have time or don't have the ability.

That is another advantage that the pharmacists’ services can offer, [but] the main thing is to really feel empathy to patients. And I've seen this across the board, whether it's on the inpatient setting or in the clinic, that if the patients see that you truly care, they really want to care for themselves that I and I've seen that over and over again.

PT Staff: As we near the end of American Heart Month and head toward International Women’s Day (March 8th), I can’t help but reflect on disparities related to care, whether it’s gender or race/ethnicity or geography- What gaps continue to persist in the treatment of heart failure?

Irina Sheyko, PharmD: Interesting that you're mentioning International Women's Day and gaps in gender. I kind of noticed that too, even with my clinic patients.

Interestingly enough, for me, a lot more referrals come for males than for females and even myself, whenever I contact them to actually make a visit/schedule a visit, it's harder for me to convince a woman to come because they will say well, “I am I can do it. I can do it on my own.” So I don't think that they selectively refer men more, it's just [they are] who are more receptive to follow through and do it.

But of course, the gap exists with like the health literacy. It definitely makes a difference and I see that in my patients too. You must really digest that information for them to understand in order for them to follow through the directions that you're giving them. So there's definitely a gap there. And we do need to identify the barriers with like the access to transportation, access to medications, whether it's the cost or even just going to get themselves.

PT Staff: How can pharmacists expand the breadth of their services?

Irina Sheyko, PharmD: First it is to really be collaborative [and] collaborate with others, show them their ability/what they can do. [Also] manage the medications and take advantage of some of the new technology that's out there so that they can tap into it and expand that way-- really show their benefit.

PT Staff: What does that collaboration look like?

Irina Sheyko, PharmD: Good question. Collaboration is really communicating with each other and see how we can all close the gap.

“How do we close that gap among ourselves?”

So if there is several months wait to see the specialist, maybe the pharmacist can close that gap to see the patient sooner and collaborate with the doctor and say, “I saw your patient, this is where we are. What do you think?” In a way, that patient has… in a way, a visit with the provider, [via that] bridge that bridge with the pharmacist.

PT Staff: How can cardiology pharmacists advance the effective use of heart medicine?

Irina Sheyko, PharmD: First of all, stay updated. So stay updated on the literature on the guidelines on the evidence. So that's one thing. And then be innovative. So now that you stay updated and have the knowledge of what's out there, [and can ask about] the choices and options [that] are available. [Also] Be innovative of how you can increase that adherence, be it motivational interviewing with the patients, or maybe some sort of system to stay adherent in terms of educating patients on utilizing pill boxes or reminders or things like that…

Image credit: Fabio Balbi | stock.adobe.com

And of course, you also look at patient factors and our being knowledgeable about the medications. You figure out which medications would be more beneficial in terms of adherence. So if it's a once daily medication, can you find a medication that's once-daily that would be easier for patients to take rather than 3 times a day?