November 14, 2011
Study Highlights:
•The rate of death and hospitalization for community-based heart failure patients remained the same whether or not they had specific consultation with a pharmacist collaborating with a physician.
•Pharmacist involvement increased the number of patients given recommended heart failure drugs, but levels of some treatments were already good at baseline.
ORLANDO, FLA., Nov. 14, 2011 ― Consultations with non-specialist pharmacists didn’t improve hospitalization or death rates for heart failure patients, according to late-breaking research 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 (1,090 patients) in Scotland to receive additional attention from a pharmacist collaborating with physicians. The pharmacists met with the patients to review their medications and ensure they had prescriptions for recommended medicines.
In another 87 centers, 1,074 patients received routine family physician care without the additional pharmacist input.
After almost five years, both groups had about the same rate of deaths and heart failure hospitalizations, approximately 35 percent.
However, the 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, M.Sc., M.P.C., the study’s lead researcher and lead Long Term Conditions/Research pharmacist at the Greater Glasgow and Clyde Health Service in Scotland, U.K. “Other studies have shown these drugs can reduce heart failure hospitalizations.”
When the study started, 14 percent of patients among both groups weren’t prescribed angiotensin-converting-enzyme inhibitors, known as ACE-inhibitors, or angiotensin-receptor blockers, often called ARBs. More than one-third (38 percent) weren’t prescribed beta-blockers. All three are highly recommended heart failure drugs.
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 their doses increased compared to 18.5 percent 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 percent 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. “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.”
Researchers should conduct long-term studies of different collaborative interventions involving different subsets of patients, such as those with severe heart failure, and look at whether hospital admissions can be prevented in these groups, Lowrie said.
Co-authors are Frances Mair, M.D.; Nicola Greenlaw, M.Sc .; Paul Forsyth, B.Sc ., M.R.Pharm.S.; Pardeep Jhund M.B., Ph.D.; Alex McConnachie, Ph.D.;Brian Rae, R.G.N.; and John J. McMurray, M.D.
Disclosures are here: http://newsroom.heart.org/pr/aha/document/Disclosures_for_LBCT.xlsx.
The National Health Service in Scotland funded the study.
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Consultation with pharmacists didn’t reduce heart failure death rates or hospitalizations / American Heart Association
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