Pharmacists who received active feedback about heart failure patients increased the frequency of interactions with their patients and prescribed more heart failure medication adjustments, according to the latest science presented today at the American Heart Association Scientific Sessions 2024. The meeting , November 16-18, 2024, in Chicago, is a leading global exchange of the latest scientific advances, research and evidence-based clinical practice updates in cardiovascular science.
Heart failure is a major public health burden, and more than 8 million adults in the US are expected to have the condition by the year 2035, according to the American Heart Association. In this study, called the PHARM-HF A&F Study, researchers provided Veterans Health Administration (VHA) primary care pharmacists with educational resources and feedback about the care they provided to patients with heart failure to assess whether this could to improve patient care by improving heart failure. medication.
Primary care pharmacists in the Veterans Health Management System are embedded in primary care panels and work closely with primary care physicians and nurse practitioners to manage medications for patients.
At VHA, primary care pharmacists can provide medication counseling, necessary monitoring, and can independently prescribe indicated treatments. They have the authority to identify people who would benefit from guideline-recommended over-the-counter treatments, such as medical treatment of heart failure, and are allowed to contact patients to initiate treatment.”
Alexander Tarlochan Singh Sandhu, MD, MS, lead author of the study, a cardiologist specializing in heart failure at Stanford University in Palo Alto, California
During the study evaluation period between January and May 2024, 120 primary care pharmacists responsible for more than 7,000 heart failure patients were randomly assigned to one of three study groups. The groups were 1) the control group, which received educational materials about the treatment protocols, monthly webinars, and a database of frequently asked questions about the management of heart failure; 2) a review and feedback group, which received educational materials and monthly review and feedback emails on HF medication management; and 3) a third group of pharmacists who received educational materials, monthly review and feedback emails, and targeted information listing HF patients who had potential for improvement with their medication.
Before the study period, each pharmacist averaged two patient visits per month involving HF care and 0.4 patient visits per month involving HF medication adjustment.
Preliminary findings show that both groups had increases in the incidence of heart failure. Pharmacists who underwent screening and received feedback had an additional significant increase in the frequency of HF patient management, with 1.2 more patient visits per month, and more HF medication adjustments, with 0.2 more visits per month compared with arm only training. However, adding access to patient-specific information in addition to controls and feedback did not lead to improved outcomes. Receiving monthly follow-up and feedback emails led to a small, but significant, increase in the frequency of prescription of a mineralocorticoid receptor antagonist medication. Historically, a mineralocorticoid receptor antagonist is the most underprescribed component of drug therapy for heart failure.
“We found that when pharmacists participated in the review and feedback group, they were more likely to identify patients who would benefit from medication adjustment, make new appointments with patients to adjust heart failure medications, and adjust drug therapy for HF during appointments, potentially leading to improved HF management and better patient outcomes,” Sandhu said.
“This shows an approach to increase the use of pharmacists to improve the use of drugs for heart failure and may also be applied to other chronic diseases,” he added. “This is an important opportunity to improve health for more patients, especially in a system like the Veterans Affairs Healthcare System with a large, robust nationwide network of pharmacists.”
A strength of this study was its hands-on approach and that it is an intervention that is highly scalable, Sandhu said. A major limitation was that the patient-specific data provided to pharmacists was not limited to their own patient list.
“The main surprise was that the patient data did not lead to an additional increase in heart failure medication adjustment,” Sandhu said. “We know that pharmacists can help improve medical care for heart failure patients, yet most pharmacists do not provide heart failure care even when they are allowed to.”
The next step in the research is to assess the long-term impact on medication adherence rates, conducting qualitative interviews with pharmacists to better understand what worked for them and how the intervention could be improved, and why the patient information was not helpful. The researchers plan to adapt and evaluate this intervention at more VHA sites next year.
Background and study details:
- The PHARM-HF A&F study included 120 Veterans Health Administration primary care pharmacists who were eligible to participate in the heart failure registry program in Northern and Central California, Nevada, Hawaii, American Samoa, and Guam.
- Pharmacists were responsible for 7,224 adults with heart failure under the care of 337 primary care teams.
- Patients had a mean age of 75 years and 98% were men.
- 65% of participants were white adults, while 14% were black adults, 5% were Asian adults, 1% were Native American or Alaska Native, 4% were Pacific Islander adults, and race was unknown. for 11%. Race was mostly self-reported by study participants rather than selected by clinicians.
- 86% of participants self-identified as non-Hispanic, 8% as Hispanic, and for 6%, ethnicity was unknown. Ethnicity was mostly self-reported by participants rather than by clinicians.
Co-authors and disclosure information are listed in the abstract. The study was funded by the American Heart Association Rural PRO-CARE Health Equity Research Network and the Veterans Affairs QUERI Program.
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