Expert Q&A: A Pharmacist's Perspective on Collaborating for Better Heart Health

In an interview with Pharmacy Times®, Kelly Rubi, PharmD, CPh, BCPS, BCACP, pharmacy clinical ambulatory specialist at Baptist Health South Florida in Miami, discussed the pharmacist’s role within the cardiovascular space, where they collaborate with other health care professionals to optimize medication management for various cardiovascular conditions, both in the inpatient and outpatient settings. Baptist Health South Florida distinguishes itself in cardiovascular care through its commitment to research, offering patients access to cutting-edge clinical trials and striving to improve outcomes and quality of life with minimally invasive treatments. Notably, they are actively involved in research for cardiac amyloidosis, which is a critical area that needs more effective therapies, Rubi explained.

Kelly Rubi, PharmD, CPh, BCPS, BCACP, pharmacy clinical ambulatory specialist at Baptist Health South Florida.

Pharmacy Times: What is the pharmacist’s role within the cardiology space, and how might it differ in the clinical ambulatory setting?

Kelly Rubi, PharmD, CPh, BCPS, BCACP: The pharmacist’s role in cardiology can be vast, as cardiology involves so many subspecialties within the inpatient and outpatient settings. This creates many opportunities for pharmacists to collaborate with health care providers. In the inpatient setting, many pharmacists round with our cardiologists and discuss treatment plans daily. Many of these pharmacists will aid with transitions of care for patients being discharged. In the ambulatory setting, we collaborate with our providers through pharmacist-led visits to provide medication management for patients with a variety of cardiovascular (CV) diagnoses, including hypertension, hyperlipidemia, sleep medicine, cardiometabolic, and heart failure.

Pharmacy Times: How might you collaborate with other health care professionals and/or specialists?

Rubi: I work within our Heart Failure and Advanced Heart Failure clinics, supporting our providers with guideline-directed medical therapy for patients with chronic heart failure (CHF), cardiac amyloidosis (ATTR-CM), pulmonary hypertension, and hypertrophic obstructive cardiomyopathy. Within these clinics, I provide resources for medication access and coordinate with other pharmacy teams—such as specialty pharmacy or infusion pharmacy—to assist with prior authorizations and ensure adherence. I also conduct pharmacist-led visits with CPA support for patients requiring titration of CHF, guideline-directed medical therapy, and patients initiated on glucagon-like peptide-1 receptor agonists for CV risk reduction.

Pharmacy Times: In the CV space, how does Baptist Health South Florida stand out compared with other institutions or health systems? What do you want to highlight?

Rubi: At Baptist Health South Florida, we are proud to have the Baptist Health Miami Cardiac & Vascular Institute and Baptist Health Medical Groups, which have served our communities for the past few decades. We strive every day to provide the highest quality care for our patients. Many of our providers are also involved in research to further advance the field of cardiology. We have a research department, as we are a site for many ongoing trials. In addition to this, our cardiometabolic clinic is affiliated with the Cardiometabolic Center Alliance. They actively recruit patients daily to be added to the CMCA Patient Registry to monitor improvements in quality of care and treatment of CV risk factors. We have pharmacists embedded in these areas, from research to clinics.

Pharmacy Times: What are some critical gaps in CV research?

Rubi: Currently, there is a need for more awareness of less common—yet serious—etiologies of HF. At Baptist Health South Florida, we are promoting awareness for ATTR-CM, an underdiagnosed disease caused by the accumulation of a protein called transthyretin within the heart [that] leads to the stiffening of the cardiac muscles and left ventricular dysfunction. ATTR can also deposit in other organs such as [the] kidneys or nerves. There are 2 types: hereditary ATTR-CM and wild-type ATTR-CM. Research is underway in this area, and there have been few advances in recent years for the management of ATTR-CM.

Pharmacy Times: As far as ongoing and/or upcoming clinical studies, what are you keeping your eye on?

Rubi: I stay updated on the latest studies by subscribing to peer-reviewed journals, such as New England Journal of Medicine and JAMA, as well as following organizations such as the American College of Cardiology, American Heart Association, and the Heart Failure Society of America.

Last month, we were excited to see that the FDA had expanded the indication for vutrisiran (Amvuttra; Alnylam Pharmaceuticals, Inc), a subcutaneous injection used to treat ATTR polyneuropathy, for the management of ATTR-CM to reduce cardiovascular mortality, CV-related hospitalization, and urgent HF visits. This is the first of its pharmacological class to observe benefits for ATTR-CM, and the study that led to its approval (HELIOS-B; NCT04153149) will likely be assessed for future guideline updates. Currently, there are only 3 agents available to treat patients with ATTR-CM, so there is a need for future studies.