Measuring the Impact of Pharmacist Interventions on Heart Failure Outcomes

Although pharmacist interventions didn't reduce hospitalizations or death rates, they did result in more patients getting the recommended medications.

Pharmacist involvement in heart failure treatment increased the number of patients who were administered recommended medications, but did not lead to improved outcomes, according to data presented at the American Heart Association’s Scientific Sessions 2011.

In the Heart Failure and Optimal Outcomes from Pharmacy Study (HOOPS), researchers randomly assigned 87 medical centers (1090 patients) in Scotland to receive additional care from a pharmacist collaborating with physicians. Pharmacists met with patients to review their medications and ensure they had prescriptions for recommended medicines.

In another 87 centers, 1074 patients received routine care from a family physician without the additional pharmacist input. After 5 five years, the rate of deaths and heart failure hospitalizations was approximately 35% in both groups. However, pharmacist consultations did increase the number of patients who received recommended heart failure medications at recommended doses.

“Even though pharmacists didn’t cut the number of deaths or hospitalizations from heart failure, the results appear to strengthen the case for optimizing heart failure drugs,” said Richard Lowrie, MSc, MPC, of Greater Glasgow and Clyde Health Service in Scotland, the study’s lead researcher. “Other studies have shown these drugs can reduce heart failure hospitalizations.”

At the start of the study, 14% of patients in both groups were not prescribed angiotensin-converting-enzyme inhibitors (ACE-inhibitors) or angiotensin-receptor blockers (ARBs), and more than one-third (38%) weren’t prescribed beta-blockers.

During the study, a third of patients in the pharmacist group who weren’t receiving the recommended drugs or who were receiving less than the recommended dose had the drugs prescribed or had their doses increased compared to 18.5% in the usual care group. Eighteen percent of patients in the pharmacist group who weren’t receiving beta-blockers or were receiving them at sub-optimal doses had those drugs started or increased, compared to 11% in the usual care group.

“While our results show that the non-specialist pharmacist intervention is not that effective in reducing hospitalization or death rates, we did demonstrate the impact pharmacists have on getting patients on recommended heart failure drugs,” Lowrie said in a statement. “This could be an important intervention in health systems with a low number of patients receiving recommended heart failure drugs. During our study, a new United Kingdom contract for family physicians incentivized the prescribing of ACE and ARBs for heart failure, which may have reduced the potential impact of this intervention.”

Long-term studies of different collaborative interventions should be conducted involving various subsets of patients, including those with severe heart failure, and it should be determined whether hospital admissions should be prevented in these patients, said Lowrie.