American Heart Month: Pharmacists as Navigators in Heart Disease Prevention and Treatment

In an interview with Pharmacy Times, Sheryl L. Chow, PharmD, FCCP, FAHA, FHFSA, associate professor of pharmacy practice and administration at Western University of Health Sciences and associate clinical professor in the Department of Medicine and Division of Cardiology at University of California, Irvine, outlined the critical and expanding role pharmacists play in cardiovascular disease (CVD) prevention and management during American Heart Month.

From reinforcing the American Heart Association’s (AHA’s) Life's Essential 8 framework and optimizing guideline-directed medical therapy in patients with heart failure (HF) to using shared decision-making and motivational interviewing to combat medication nonadherence, Chow described pharmacists as indispensable health care navigators within the growing cardiovascular-kidney-metabolic syndrome framework.

Pharmacy Times: American Heart Month is a key time to highlight cardiovascular prevention. What are the most important evidence-based messages pharmacists should reinforce with patients to reduce heart disease risk?

Sheryl L. Chow, PharmD, FCCP, FAHA, FHFSA: Behavioral and lifestyle interventions should begin early in life and be sustained across the life span to prevent or delay the onset of cardiovascular disease. AHA’s Life’s Essential 8 framework emphasizes optimization of 8 modifiable cardiovascular health metrics: dietary quality, physical activity, tobacco cessation, body mass index, glycemic control, lipid management, blood pressure control, and sleep health.¹

These foundational elements remain central to cardiovascular risk reduction and must be reinforced alongside appropriate pharmacotherapy. Pharmacists play a critical role in translating these evidence-based lifestyle recommendations into actionable, patient-centered strategies while ensuring optimal [cardiovascular] medication management.¹

Pharmacy Times: HF remains a leading cause of morbidity and mortality. What practical tips can pharmacists use to support patients with HF in optimizing their medication regimens and improving outcomes?

Chow: Given their accessibility and pharmacotherapeutic expertise, pharmacists are uniquely positioned to identify and address patient-specific barriers to care, including medication cost, insurance limitations, transportation challenges, and health literacy gaps. Multidisciplinary, team-based care remains the foundation of heart failure management, and clinical pharmacists serve as integral members of this team by selecting and optimizing guideline-directed medical therapy (GDMT) based on clinical status, laboratory parameters, comorbidities, hemodynamics, and other individualized factors.

Importantly, there has been a paradigm shift in the management of symptomatic heart failure with reduced ejection fraction (HFrEF, stage C). The historical “start low and go slow” titration strategy has evolved toward rapid sequencing and early implementation of important GDMT. Current evidence, including findings from STRONG-HF (NCT03412201), supports early initiation and up-titration of renin–angiotensin system inhibitors, angiotensin II receptor blockers, and sacubitril/valsartan (Entresto; Novartis), β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors—ideally within 2 weeks following hospitalization—to improve clinical outcomes and quality of life.^2,3

Even in patients at risk for hypotension, it is generally preferable to initiate all 4 foundational agents at lower doses early rather than staggering therapy over several months. Pharmacists play a pivotal role in monitoring tolerability, managing adverse effects, and facilitating safe titration.

Pharmacists play an essential role in optimizing guideline-directed medical therapy, facilitating transitions of care, ensuring medication reconciliation accuracy, preventing readmissions, and advancing preventive cardiovascular care initiatives—not only during American Heart Month but throughout the year. - Sheryl L. Chow, PharmD, FCCP, FAHA, FHFSA

Pharmacy Times: Given your experience with cardiovascular clinical pharmacology, how can pharmacists better incorporate discussions about complementary therapies and supplements into heart disease management without compromising safety?

Chow: Pharmacists should approach discussions about complementary and alternative medicine (CAM) with openness, cultural sensitivity, and without judgment. Roughly 70% of patients do not disclose alternative therapy use to health care providers, and many clinicians do not routinely inquire, document, or monitor dietary supplement use. This gap creates potential safety risks, particularly in patients with cardiovascular disease.⁴

Pharmacists should proactively incorporate targeted questions about herbal products, dietary supplements, and nonprescription OTC therapies into medication reconciliation processes. Direct inquiry regarding diet, supplements, and herbal use should become standard practice in both inpatient and outpatient settings.

When evaluating CAM therapies, clinicians should consider whether the intervention is:

• Supported by evidence demonstrating safety and efficacy
• Potentially effective but associated with safety concerns
• Inadequately studied but likely low risk
• Ineffective and potentially harmful

Current American College of Cardiology (ACC)/AHA/Heart Failure Society of America heart failure guidelines do not generally recommend alternative therapies (except fish oil) for survival benefit and caution against their use due to potential safety concerns. However, emerging data continue to evolve, and upcoming guideline updates may reassess the strength of evidence for select agents.^5,6

Studies demonstrate that health care professionals often lack sufficient knowledge and confidence in counseling patients about CAM therapies. Pharmacists, with expertise in pharmacodynamics and pharmacokinetics, are well positioned to evaluate nutrient-drug interactions and provide evidence-based counseling within a multidisciplinary framework. Our AHA Scientific Statement and appendix published in Circulation are referenced below and are intended for both health care professionals and the public. It contains useful drug interaction tables, summary evidence tables, and counseling points.^5,6

Pharmacy Times: Biomarkers like natriuretic peptides and troponin are increasingly used in heart failure care and risk stratification. What should pharmacists know about interpreting and acting on these results in collaboration with prescribers?

Chow: Recent AHA/ACC heart failure guideline updates recommend the use of natriuretic peptides (BNP or NT-proBNP) for diagnosis and risk stratification in patients with acute decompensated heart failure. Biomarker assessment prior to hospital discharge is also recommended to inform prognosis and guide follow-up planning.^6,7

Although routine biomarker-guided titration of therapy requires further study, practical applications exist in clinical practice. High-sensitivity troponin and natriuretic peptides are increasingly used to identify patients at risk for incident heart failure or worsening CVD. These data can support intensification of GDMT within the parameters of guidelines and closer monitoring strategies to mitigate disease progression.^6,7

Pharmacy Times: Medication adherence is a persistent challenge in chronic CVD. From your perspective, what strategies have shown the most promise in helping patients stay on heart-protective therapies long term?

Chow: Clinical inertia remains a major barrier in cardiovascular disease management. Addressing social determinants of health, including health care access, financial instability, transportation barriers, and medication affordability, is essential to improving long-term adherence.⁸

In addition, misinformation, distrust of scientific institutions, and health-related conspiracy beliefs may undermine adherence. Identifying these concerns through empathetic communication is critical.⁸

A shared decision-making framework that emphasizes patient-centered care, aligns therapy with patient values and preferences, and fosters collaborative goal setting has shown promise in improving long-term adherence. Pharmacists can reinforce education, simplify regimens when feasible, and engage in motivational interviewing techniques to support sustained therapy.⁸

Pharmacy Times: As pharmacists take on more clinically integrated roles in cardiovascular care teams, what opportunities do you see for them to impact patient education, preventive care, and transition of care services during American Heart Month and beyond?

Chow: AHA’s 2023 Presidential Advisory introduced cardiovascular-kidney-metabolic (CKM) syndrome, defined as a health disorder characterized by the interconnection of cardiovascular disease, chronic kidney disease, diabetes, and obesity, leading to adverse health outcomes. The CKM staging system underscores the need for integrated, interdisciplinary care.

The PREVENT risk score calculator was developed by our AHA Scientific Advisory Group and can be found here.⁹

Within this framework, pharmacists are uniquely positioned to serve as health care navigators who bridge communication gaps among generalists, specialists, and other health care professionals. Their accessibility, particularly in community settings, also allows for proactive risk screening, education on prevention strategies, and reinforcement of lifestyle and pharmacologic interventions.

Pharmacists play an essential role in optimizing GDMT, facilitating transitions of care, ensuring medication reconciliation accuracy, preventing readmissions, and advancing preventive cardiovascular care initiatives—not only during American Heart Month but throughout the year.¹⁰

REFERENCES

1. Lloyd-Jones DM, Allen NB, Anderson CAM, et al; American Heart Association. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078

2. Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised trial. Lancet. 2022;400(10367):1938-1952. doi:10.1016/S0140-6736(22)02076-1

3. Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP testinG, of Heart Failure therapies (STRONG-HF). ClinicalTrials.gov. Updated February 12, 2021. Accessed February 25, 2026. https://clinicaltrials.gov/study/NCT03412201

4. Ventola CL. P&T. 2010;35(8):461-468. Accessed via: Chow SL. Nutraceuticals in heart failure prevention. Presented at: 15th Annual Orange County Symposium for Cardiovascular Disease Prevention; October 28, 2023; Irvine, CA. Accessed February 25, 2026. https://medschool.uci.edu/sites/default/files/2023-10/Chow_OCSymposium2023_0.pdf

5. Chow SL, Bozkurt B, Baker WL, et al; American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2023;147(2):e4-e30. doi:10.1161/CIR.0000000000001110

6. Heidenreich PA, Bozkurt B, Aguilar D, et al; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(8):e895-e1032. doi:10.1161/CIR.0000000000001063

7. Chow SL, Maisel AS, Anand I, et al; American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Epidemiology and Prevention; Council on Functional Genomics and Translational Biology; and Council on Quality of Care and Outcomes Research. Role of biomarkers for the prevention, assessment, and management of heart failure: a scientific statement from the American Heart Association. Circulation. 2017;135(22):e1054-e1091. doi:10.1161/CIR.0000000000000490

8. Page RL 2nd, Chow SL. Polypharmacy and the clinical inertia conundrum for GDMT. JACC Heart Fail. 2023;11(11):1518-1520. doi:10.1016/j.jchf.2023.08.015

9. The American Heart Association PREVENT Online Calculator. American Heart Association Professional Heart Daily. Accessed February 25, 2026. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

10. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606-1635. doi:10.1161/CIR.0000000000001184