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Published in: Heart and Vessels 6/2018

01-06-2018 | Original Article

Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication

Authors: Masanori Suzuki, Yuya Matsue, Sayaka Izumi, Ayako Kimura, Tomoaki Hashimoto, Kentaro Otomo, Hiroshi Saito, Makoto Suzuki, Yasuhisa Kato, Ryohkan Funakoshi

Published in: Heart and Vessels | Issue 6/2018

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Abstract

We evaluated the impact of pharmacist-led heart failure (HF) drug recommendations during hospitalization for hospitalized patients with HF. Hospitalized patients with HF were retrospectively reviewed. Patients were hospitalized before (n = 208, non-intervention group) or after (n = 170, intervention group) the launch of the HF multidisciplinary team (HFMDT) approach with pharmacist-led HF medication optimization. There were no significant group differences in patient background characteristics at admission. Patients with HF with reduced ejection fraction who were not on beta blockers or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACE-I/ARB) at admission were significantly more likely to be on beta blockers at the time of discharge in the intervention group (73.3 vs 96.3%, P = 0.027) compared to those in non-intervention group; however, the change in ACE-I/ARB prescriptions was not significant (53.3 vs 63.3%, P = 0.601). The proportion of patients on any drug with recommendations against its use in patients with HF did not change from admission to discharge in the non-intervention group (21.2 vs. 20.2%, P = 0.855), but was significantly reduced in the intervention group (22.9 vs. 12.9%, P = 0.005). There were no group differences in the in-hospital all-cause mortality (non-intervention, 3.4%; intervention, 2.4%; P = 0.761) or length of hospital stay (median: non-intervention, 13 days; intervention, 14 days; P = 0.508). Pharmacist-led HF drug recommendations during hospitalization as part of a HFMDT approach for hospitalized patients with HF can increase beta blocker prescriptions and decrease non-preferred drug prescriptions.
Literature
1.
go back to reference Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology F, American Heart Association Task Force on Practice G (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239CrossRefPubMed Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology F, American Heart Association Task Force on Practice G (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239CrossRefPubMed
2.
go back to reference Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefPubMed Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefPubMed
3.
go back to reference Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P, Tavazzi L, Investigators Q (2016) Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail 18:514–522CrossRefPubMed Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P, Tavazzi L, Investigators Q (2016) Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail 18:514–522CrossRefPubMed
4.
go back to reference Hamaguchi S, Kinugawa S, Sobirin MA, Goto D, Tsuchihashi-Makaya M, Yamada S, Yokoshiki H, Tsutsui H, Investigators J-C (2012) Mode of death in patients with heart failure and reduced vs. preserved ejection fraction: report from the registry of hospitalized heart failure patients. Circ J 76:1662–1669CrossRefPubMed Hamaguchi S, Kinugawa S, Sobirin MA, Goto D, Tsuchihashi-Makaya M, Yamada S, Yokoshiki H, Tsutsui H, Investigators J-C (2012) Mode of death in patients with heart failure and reduced vs. preserved ejection fraction: report from the registry of hospitalized heart failure patients. Circ J 76:1662–1669CrossRefPubMed
5.
go back to reference Okuda S, Yano M (2011) Guidelines for treatment of chronic heart failure (JCS 2010). Nihon Rinsho 69(Suppl 9):595–604PubMed Okuda S, Yano M (2011) Guidelines for treatment of chronic heart failure (JCS 2010). Nihon Rinsho 69(Suppl 9):595–604PubMed
6.
go back to reference Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L (2005) Systematic review of multidisciplinary interventions in heart failure. Heart 91:899–906CrossRefPubMedPubMedCentral Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L (2005) Systematic review of multidisciplinary interventions in heart failure. Heart 91:899–906CrossRefPubMedPubMedCentral
7.
go back to reference McAlister FA, Stewart S, Ferrua S, McMurray JJ (2004) Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 44:810–819PubMed McAlister FA, Stewart S, Ferrua S, McMurray JJ (2004) Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 44:810–819PubMed
8.
go back to reference Lowrie R, Mair FS, Greenlaw N, Forsyth P, Jhund PS, McConnachie A, Rae B, McMurray JJ, Heart Failure Optimal Outcomes from Pharmacy Study I (2012) Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. Eur Heart J 33:314–324CrossRefPubMed Lowrie R, Mair FS, Greenlaw N, Forsyth P, Jhund PS, McConnachie A, Rae B, McMurray JJ, Heart Failure Optimal Outcomes from Pharmacy Study I (2012) Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. Eur Heart J 33:314–324CrossRefPubMed
9.
go back to reference Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT (2008) Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med 168:687–694CrossRefPubMed Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT (2008) Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med 168:687–694CrossRefPubMed
10.
go back to reference Holland R, Brooksby I, Lenaghan E, Ashton K, Hay L, Smith R, Shepstone L, Lipp A, Daly C, Howe A, Hall R, Harvey I (2007) Effectiveness of visits from community pharmacists for patients with heart failure: heartMed randomised controlled trial. BMJ 334:1098CrossRefPubMedPubMedCentral Holland R, Brooksby I, Lenaghan E, Ashton K, Hay L, Smith R, Shepstone L, Lipp A, Daly C, Howe A, Hall R, Harvey I (2007) Effectiveness of visits from community pharmacists for patients with heart failure: heartMed randomised controlled trial. BMJ 334:1098CrossRefPubMedPubMedCentral
11.
go back to reference Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, Stroupe KT, Wu J, Clark D, Smith F, Gradus-Pizlo I, Weinberger M, Brater DC (2007) Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 146:714–725CrossRefPubMed Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, Stroupe KT, Wu J, Clark D, Smith F, Gradus-Pizlo I, Weinberger M, Brater DC (2007) Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 146:714–725CrossRefPubMed
12.
go back to reference Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM (1999) Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Arch Intern Med 159:1939–1945CrossRefPubMed Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM (1999) Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Arch Intern Med 159:1939–1945CrossRefPubMed
13.
go back to reference Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D (1993) Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 88:107–115CrossRefPubMed Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D (1993) Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 88:107–115CrossRefPubMed
14.
go back to reference McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Guidelines ESCCfP (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Guidelines ESCCfP (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847CrossRefPubMed
15.
go back to reference Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, Redelmeier DA (2004) Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med 351:543–551CrossRefPubMed Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, Redelmeier DA (2004) Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med 351:543–551CrossRefPubMed
16.
go back to reference Milfred-Laforest SK, Chow SL, Didomenico RJ, Dracup K, Ensor CR, Gattis-Stough W, Heywood JT, Lindenfeld J, Page RL 2nd, Patterson JH, Vardeny O, Massie BM (2013) Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. J Card Fail 19:354–369CrossRefPubMed Milfred-Laforest SK, Chow SL, Didomenico RJ, Dracup K, Ensor CR, Gattis-Stough W, Heywood JT, Lindenfeld J, Page RL 2nd, Patterson JH, Vardeny O, Massie BM (2013) Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. J Card Fail 19:354–369CrossRefPubMed
17.
go back to reference Eggink RN, Lenderink AW, Widdershoven JW, van den Bemt PM (2010) The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci 32:759–766CrossRefPubMedPubMedCentral Eggink RN, Lenderink AW, Widdershoven JW, van den Bemt PM (2010) The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci 32:759–766CrossRefPubMedPubMedCentral
18.
go back to reference Gwadry-Sridhar FH, Arnold JM, Zhang Y, Brown JE, Marchiori G, Guyatt G (2005) Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure. Am Heart J 150:982CrossRefPubMed Gwadry-Sridhar FH, Arnold JM, Zhang Y, Brown JE, Marchiori G, Guyatt G (2005) Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure. Am Heart J 150:982CrossRefPubMed
19.
go back to reference Luzier AB, Forrest A, Feuerstein SG, Schentag JJ, Izzo JL Jr (2000) Containment of heart failure hospitalizations and cost by angiotensin-converting enzyme inhibitor dosage optimization. Am J Cardiol 86:519–523CrossRefPubMed Luzier AB, Forrest A, Feuerstein SG, Schentag JJ, Izzo JL Jr (2000) Containment of heart failure hospitalizations and cost by angiotensin-converting enzyme inhibitor dosage optimization. Am J Cardiol 86:519–523CrossRefPubMed
20.
go back to reference Rainville EC (1999) Impact of pharmacist interventions on hospital readmissions for heart failure. Am J Health Syst Pharm 56:1339–1342PubMed Rainville EC (1999) Impact of pharmacist interventions on hospital readmissions for heart failure. Am J Health Syst Pharm 56:1339–1342PubMed
21.
go back to reference Masoudi FA, Rathore SS, Wang Y, Havranek EP, Curtis JP, Foody JM, Krumholz HM (2004) National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation 110:724–731CrossRefPubMed Masoudi FA, Rathore SS, Wang Y, Havranek EP, Curtis JP, Foody JM, Krumholz HM (2004) National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation 110:724–731CrossRefPubMed
22.
go back to reference Sanam K, Bhatia V, Bajaj NS, Gaba S, Morgan CJ, Fonarow GC, Butler J, Deedwania P, Prabhu SD, Wu WC, White M, Love TE, Aronow WS, Fletcher RD, Allman RM, Ahmed A (2016) Renin-angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure. Am J Med 129:1067–1073CrossRefPubMedPubMedCentral Sanam K, Bhatia V, Bajaj NS, Gaba S, Morgan CJ, Fonarow GC, Butler J, Deedwania P, Prabhu SD, Wu WC, White M, Love TE, Aronow WS, Fletcher RD, Allman RM, Ahmed A (2016) Renin-angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure. Am J Med 129:1067–1073CrossRefPubMedPubMedCentral
23.
go back to reference Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD, Smith EE, Heidenreich P, Hernandez AF, Yancy CW, Bhatt DL (2017) Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J Am Heart Assoc 6(2):e004675. https://doi.org/10.1161/JAHA.116.004675 CrossRefPubMedPubMedCentral Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD, Smith EE, Heidenreich P, Hernandez AF, Yancy CW, Bhatt DL (2017) Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J Am Heart Assoc 6(2):e004675. https://​doi.​org/​10.​1161/​JAHA.​116.​004675 CrossRefPubMedPubMedCentral
24.
go back to reference Damman K, Tang WH, Felker GM, Lassus J, Zannad F, Krum H, McMurray JJ (2014) Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. J Am Coll Cardiol 63:853–871CrossRefPubMed Damman K, Tang WH, Felker GM, Lassus J, Zannad F, Krum H, McMurray JJ (2014) Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. J Am Coll Cardiol 63:853–871CrossRefPubMed
25.
go back to reference Roblek T, Deticek A, Leskovar B, Suskovic S, Horvat M, Belic A, Mrhar A, Lainscak M (2016) Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: a randomized, double-blind, controlled trial. Int J Cardiol 203:647–652CrossRefPubMed Roblek T, Deticek A, Leskovar B, Suskovic S, Horvat M, Belic A, Mrhar A, Lainscak M (2016) Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: a randomized, double-blind, controlled trial. Int J Cardiol 203:647–652CrossRefPubMed
Metadata
Title
Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication
Authors
Masanori Suzuki
Yuya Matsue
Sayaka Izumi
Ayako Kimura
Tomoaki Hashimoto
Kentaro Otomo
Hiroshi Saito
Makoto Suzuki
Yasuhisa Kato
Ryohkan Funakoshi
Publication date
01-06-2018
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 6/2018
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-017-1099-8

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