Pharmacist Intervention with Heart Failure Patients

Orlando—Patients with left ventricular systolic dysfunction who visited pharmacists did not experience a significant decrease in death or hospital admissions compared with a group that did not have pharmacist intervention, according to a prospective, cluster, randomized, controlled trial. The HOOPS (Heart Failure and Optimal Outcomes from Pharmacy Study) trial also found that there was a significant improvement in patients starting or increasing their dosage of heart medications after 1 year of meeting with the pharmacists. Richard Lowrie, MSc, MPC, the study’s lead researcher and the lead long-term conditions/research pharmacist at the Greater Glasgow and Clyde Health Service in Scotland, United Kingdom, presented the results in a late-breaking clinical trial session at the AHA meeting. Mr. Lowrie said the investigators “had good reason to study this particular topic” because medicines for heart failure such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are underused and underdosed. The authors wanted to study pharmacists who evaluated medications and worked with patients’ families and doctors to make recommendations. They were interested in determining how the collaboration would impact hospitalizations and mortality. Patients were included if they had left ventricular systolic dysfunction confirmed by echocardiography. Patients with more severe symptoms were excluded, including those who were admitted to the hospital for heart failure and then recently discharged and followed up on a regular basis by a specialty nurse. The intervention included 27 pharmacists who initially met with patients in the family medical center for an average of 30 minutes to discuss the medication review. If they made changes such as treatment initiation or dose modification during the first visit, patients and pharmacists met an additional 3 to 4 times. The study enrolled 2164 patients from family medical centers in Scotland who were randomized according to their medical center between October 2004 and September 2007. There were 2 groups: 1074 patients from 87 practices were in the usual care group and 1090 patients from 87 practices were in the pharmacist intervention group. The usual care group was comprised of patients with heart failure who had routine visits with general physicians. The authors collected patient data at baseline and also drug-prescribing data at 1- and 2- year follow-up periods. The median follow-up was 4.7 years. The average age of patients at baseline was approximately 71 years, and approximately 70% of patients were males. The patients had a “complex set of comorbidities,” according to Mr. Lowrie. In the intervention group, 35.8% of patients died or were hospitalized for heart failure compared with 35.4% of patients in the usual care group (P=.72). When the researchers separated the composite outcome into the mortality and nonmortality categories after 5 years, they found a lower number of heart failure hospitalizations (approximately 10% in both groups) compared with all-cause mortality (approximately 30% in both groups). The pharmacist intervention group was significantly more likely to begin taking or adjust their dosage. After 1 year, 33.1% of patients in the intervention group started or adjusted their dosage of ACE inhibitors or angiotensin II receptor blockers compared with 18.5% in the usual care group (P<.001). In addition, 17.9% of patients in the intervention group started or adjusted their dosage of beta-blockers after 1 year compared with 11.1% in the usual care group (P<.001).