4 Heart Failure Management Tips for Community Pharmacists

Heart failure is a leading cause of emergency room visits and hospital readmissions.

Recent study results published in the Annals of Family Medicine uncovered that a full quarter of heart failure patients discharged from the hospital will be readmitted within 30 days, and half of them will be back at the hospital within 6 months.

Transitional care interventions have been shown to reduce readmissions and emergency room visits among discharged heart failure patients. Much of the transitional care follow up is performed by the hospital discharge team, but the community pharmacist is in a unique position to provide another level of education to patients or caregivers when they pick up their prescriptions.

An understanding of the following items may help community pharmacists prepare to offer care interventions to newly discharged heart failure patients.

1. Educate the patient and caregiver about heart failure.

It is important for patients to understand that having heart failure does not mean that their heart is about to stop. Rather, their heart is not able to pump enough blood to meet their body’s needs, or it is not filling up quickly enough. The blood may back up and cause swelling in the feet, ankles, and legs, and it may also cause some shortness of breath and fatigue.

Heart failure development is a slow process and usually caused by diseases that affect the heart for an extended period of time, such as high blood pressure, coronary artery disease, and diabetes.

2. Make sure that patients are on evidence-based medicines and not taking contraindicated therapy.

Recommended drugs for heart failure include:

• Diuretics: recommended unless contraindicated in patients with evidence of fluid retention in order to improve symptoms.
• Angiotensin-converting enzyme (ACE) inhibitors: recommended unless contraindicated in patients in order to improve morbidity and mortality.
• Angiotensin receptor blockers (ARBs): recommended unless contraindicated when patient cannot tolerate ACE inhibitors in order to improve morbidity and mortality.
• Beta-blockers: only carvedilol, bisoprolol, or metoprolol succinate are recommended unless contraindicated in order to reduce mortality
• Aldosterone receptor antagonists, digoxin, or isosorbide and hydralazine: recommended for patients who are on optimized therapy with both an ACE or ARB and an appropriate beta-blocker and still need further treatment. Specific dosing parameters and monitoring criteria need to be followed.
• Omega-3 fatty acid supplementation: reasonable in specific situations when not contraindicated.

Drugs that are not recommended for heart failure include:

• Statins: have not shown any benefit in treating chronic heart failure and should not be prescribed when no other indication is present.
• Calcium channel blockers: show no benefit and not recommended.
• Nonsteroidal anti-inflammatory drugs: may lead to increased sodium retention, fluid retention, and an increased morbidity and mortality.
• Thiazolidinediones: associated with increased incidence of heart failure events and should not be used.

3. Empower the patient to self-monitor for heart failure symptoms.

These symptoms include:

• Weight gain or ankle swelling
• Increased shortness of breath
• Increased dizziness upon rising
• Recent loss of appetite
• Difficulty sleeping

4. Discuss the importance of medication adherence with the patient through open-ended questions.

Such questions may include:

• How do you organize your medications at home?
• What systems do you have in place to help you remember to take your medications? If the patient has none, offer suggestions such a pillbox.

When patients understand why they are taking their medications and the consequences of not taking them, they are more likely to participate in their own care. Community pharmacists are positioned to help heart failure patients achieve the best possible outcome of therapy.

Reference

Vedel I, Khanassov V. Transitional care for patients with congestive heart failure: a systematic review and meta-analysis. Ann Fam Med. 2015 Nov;13(6):562-71. doi: 10.1370/afm.1844.