Multidisciplinary Teams Including Pharmacists Improve Heart Failure Outcomes

Pharmacists working along with other health care providers can help improve outcomes for heart failure patients, according to the results of a pair of studies presented at the Heart Failure Society of America meeting.

Pharmacists working in teams alongside primary care physicians, cardiologists, and nurses can help improve care of heart failure patients, according to 2 new studies presented on September 23, 2013, at the Heart Failure Society of America meeting in Orlando, Florida.

The first study analyzed the effects of a pilot pharmacist and nurse team in a primary care clinic on the outcomes of heart failure patients. A total of 46 heart failure patients older than 18 were enrolled from a practice of 10 primary care physicians to participate in the program, based on hospital or physician referral, between January and October 2012. The minimum intervention provided by the pharmacist and nurse teams included early contact with each patient, in-person assessments, medication reconciliation, heart failure education, and helping patients to develop self-care goals. The teams provided additional follow-up with patients as needed in person, over the phone, or by email. Demographic and clinical data for each patient were recorded throughout the study and compared with their previous outcomes.

The results indicated that the pharmacist and nurse team improved access to care, reduced hospital use, and improved patient outcomes and self-care. On average, patients in the pharmacist and nurse group contacted a clinic for the first time 2.6 days after discharge, compared with 5.1 days for the control group. Patients who were cared for by the pharmacist and nurse team experienced a 35% reduction in the total number of all-cause admissions compared with the same period during the year before the study. A vast majority (83%) of personal health goals set by patients cared for by the pharmacist and nurse team were achieved by the end of the program as well. The pharmacist and nurse team changed 174 medications and conducted 81 medication adherence interventions throughout the study period, as 49% of patients were non-adherent to at least 1 medication. Surveys given at the end of the pilot indicated that both patients and physicians were satisfied with the team care.

Similar results were found in a second study in which a multidisciplinary heart failure disease management program, including cardiologists, nurses, and pharmacists, succeeded in improving quality-of-life scores in heart failure patients. Researchers enrolled patients with acute heart failure admitted to a large Veterans Administration hospital from October 2008 to September 2011, offering them care through the multidisciplinary management program after discharge.

The program included 706 patients who completed either the Kansas City Cardiomyopathy Questionnaire (KCCQ) or the Minnesota Living With Heart Failure Questionnaire (MLWHF) to asses quality of life at baseline. Participants completed the questionnaires again at 1-, 3-, 6-, and 12-month follow-ups. Scores for both tests significantly improved within the first month and were sustained through 3 and 6 months. After 1 year, scores were still improved, although the improvements were no longer statistically significant. (Scores on the MLWHF, however, showed a “very strong trend for significance,” according to the study abstract.)

Both studies indicate the importance of team care in managing high risk patients and the significant role pharmacists can play in improving patient care.