Elderly patients with heart failure adhered better to their recommended medications when they saw a pharmacist once a week, according to late breaking results from the PHARM-CHF randomized controlled trial presented this week at Heart Failure 2019, a scientific congress of the European Society of Cardiology (ESC).1

The PHARM-CHF trial looked at data from 237 ambulatory patients with chronic heart failure aged 60 years and older who were randomly assigned to usual care or a pharmacy intervention, and followed-up for a median of 2 years. The average age was 74 years, 62% were male, and the median number of different medications was 9.

The intervention started with a medication review. Patients brought their medications to a pharmacist who made a medication plan, checked for drug interactions and double medications, and contacted the physician about any risks. Patients then visited the pharmacy every 8–10 days to discuss adherence and symptoms, and have their blood pressure checked and pulse rate measurements collected. Drugs were provided in a pillbox with compartments for morning, noon, evening, and night on each day. The pharmacist updated the medication plan if needed and contacted their physician with new drug-related problems or significant changes in vital signs.

The primary efficacy endpoint was the proportion of days that 3 heart failure medications were collected (using pharmacy claims data) in the year after randomization. The drugs were beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists. Compared to usual care, the intervention resulted in a significant 5.7% absolute increase in collection.

The researchers also calculated the proportion of patients who collected the 3 drugs at least 80% of the days under study (defined as adherent) compared to baseline. The proportion of adherent patients increased from 44% to 86% in the pharmacy group and from 42% to 68% in the usual care group–a significant 18%-points difference between groups. Patients in the pharmacy group were 3 times more likely to become adherent compared to the usual care group. 

There was no difference between groups in the primary composite safety endpoint of days lost in the year following randomisation due to unplanned cardiovascular hospitalizations or all-cause death.

Improvement in quality of life was more pronounced in the pharmacy group after 1 year and significantly better compared to the usual care group after 2 years. This meant patients in the pharmacy group were less limited in their daily activities and less worried about their disease.

“Adhering to a complex medication regimen is a huge challenge for elderly patients with heart failure,” said co-principal investigator Professor Martin Schulz, of the Department of Clinical Pharmacy, Freie Universitaet Berlin, Germany, said in a press release about the findings. “It is estimated that 30% to 50% of patients in Europe are nonadherent to heart failure medications, which results in increased frequency and severity of symptoms such as breathlessness, worsening heart failure and consequent hospitalisations, and higher mortality.”


Reference

Schulz M. Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM-CHF randomized controlled trial. Heart Failure 2019. May 25-28, 2019. Athens.