Providers | Pharmacists

Essential role of clinical pharmacists in improving CHF patient outcomes

December 10, 2020 

By Kristen Engelen, PharmD

Over 6.2 million U.S. adults have heart failure, costing 868,000 persons their lives each year, reports the American Heart Association in its “2020 Heart Disease and Stroke Statistics” report. Heart disease, stroke and other cardiovascular diseases cost the nation more than $30 billion in healthcare services, medications to treat heart failure, and missed days of work. By 2030, these figures are expected to rise to more than 8 million adults with cardiac disease and the nation’s annual cost increasing to over $69 billion.

Add to the challenges in creating and managing a care plan for a growing number of HF patients, another factor is the challenges and opportunities of a wealth of new treatment options. There are a plethora of new medications and therapeutic biological products being introduced each year — or novel uses of existing medications — to thoughtfully consider which are designed to help achieve and maintain optimal health (46 in 2020 alone, as of Nov. 25 according to the FDA). It’s a lot for a busy physician and his/her care team to weigh while building a cardiac rehab/health program that’s best suited to each patient’s condition, genetic background and lifestyle.

As noted by Amar Bhakta, MD, of Rush University Medical Center in a video clip from the American Heart Association 2017 Scientific Sessions, here’s where clinical pharmacists are in a unique position to provide the latest pharmacologic and pharmacogenetic information to both patients and providers on the latest advances impacting cardiac treatment and management. As an integral member of the multidisciplinary care team, pharmacists also help monitor and optimize medication adherence, evaluate social determinants of health, and be another invaluable touch point in drilling down to help assess the patient’s symptoms, actions and concerns.

Clinical pharmacists’ role in HF care

Although each care setting (inpatient vs. outpatient or home) provides a unique opportunity for different types of clinical pharmacist contributions/interventions, in “Current Perspectives on the Role of the Pharmacist in Heart Failure Management (Integrated Pharmacy Research & Practice), the author notes there are a few important aspects of services that appear to be consistent performed across different care settings. These include medication reconciliation and patient medication education; providing pharmacotherapeutic recommendations and monitoring (including drug initiation, adjustment and monitoring); early identification and prevention of adverse drug reactions and interactions; and improving medication adherence, access to medications and facilitating smooth transitions of care.

HF patients have complex medical regimens, require frequent dosage changes and modifications, and usually have multiple other comorbidities. These factors increase the likelihood for medication discrepancies, particularly with transitions of care from hospital to community/home or when elements of care are being guided by more than one practice.

Though medication reconciliations are often performed by many different healthcare professionals (physicians, nurses, etc.), in “Pharmacist Care of Patients with Heart Failure: A Systematic Review of Randomized Trials(Archives of Internal Medicine), the authors note that numerous studies have found that when pharmacists were involved in medication reconciliation and ongoing management, especially as part of a multidisciplinary team, it’s led to a significant reduction in medication errors as well as a great reduced risk for all-cause and HF-specific hospitalization, readmissions and/or ED visits. This has been accompanied by improvement of patient knowledge retention and the resulting clinical outcomes.

In “Interventions to Improve Safe and Effective Medicines Use by Consumers: An Overview of Systematic Reviews (Cochrane Database Systems Review), Ryan et al. note that one-on-one consultations of pharmacist and patient have been shown to uncover and resolve medication problems and develop and improve patient buy-in on an evidence-driven but customized care plan, again with positive effects on adherence and knowledge.

(The RxLive team has the unique ability to examine the data that sits behind the patient population it serves. For all patients with heart failure who have consulted with an RxLive clinical pharmacist from August 2019 through November 2020, 10% of medications related to HF management were changed as a result of the pharmacist consult.)

Pharmacists critical component of team-based TOC

As with all patients and conditions, managing transitions of care — whether from hospital floor to floor, shift to shift or moving from a hospital to a community/home environment — is critical to optimal health outcomes for patients with heart failure (“A Review of the Role of the Pharmacist in Heart Failure Transition of Care,” Advances in Therapy). It’s true that within any transition of care “handoff,” medication reconciliation can easily become out of sync, and other care elements can go awry that lead to increased morbidity, mortality and costs. These can manifest through a higher number of avoidable medical errors (AMEs), hospital readmissions, and trips to the ED. The overwhelming majority of these can be avoided by a multidisciplinary, well-coordinated care team including a clinical pharmacist to continue services in the patient’s comfortable home environment.

Summary: The value of a clinical pharmacist to optimize outcomes

Today, clinical pharmacists play a growing role within the multidisciplinary care team in the care of patients with heart failure…or with virtually any other conditions, for that matter. It’s been evaluated and well-documented that pharmacists help improve outcomes across the board — clinical, financial and satisfaction. They do this by providing medication reconciliation and management especially during transition of care and continued follow-up; patient education regarding their medications; enable better patient self-care; and provide the care team with expert knowledge of medications. Pharmacists also provide much-needed support for office-based members of the care team already hard-pressed to deliver other facets of care, especially during the current pandemic.

As soon-to-be-released COVID-19 vaccines become available over the next months, we will be watching with anticipation as to what type of “new normal” world we will be facing. But we anticipate the continued growth of the role and responsibilities of clinical pharmacists, and embracing of the convenience and safety of services provided via telehealth that didn’t exist across some of the population before this last year dramatically showed its worth.

At RxLive, we continue to closely monitor advances of innovative treatment and care options developed for HF and other patient disease states, and will pass along these new pharmacological options as they become available. Our staff are both glad and proud to be a member of the multidisciplinary teams of an expanding number of practices throughout the country. Let us know if we can help you as a provider, or as a clinical pharmacist who might be interesting in joining our team.

Resources/references

Heart Disease and Stroke Statistics — 2020 Update: A Report from the American Heart Association (full online report)
CDC facts on the incidence of heart failure in the U.S. (web page)
“Current Perspectives on the Role of the Pharmacist in Heart Failure Management,” (2018, web page)
“A Review of the Role of the Pharmacist in Heart Failure Transition of Care,” (2018, web page)
“Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure,” (Current Heart Failure Reports, 2017 web page)
“Pharmacist Care of Patients with Heart Failure: A Systematic Review of Randomized Trials,” (Archives of Internal Medicine, 2008, web page)

 

Kristen Engelen, Pharm D

Kristen Engelen, Pharm D

Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.
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