AHA 2024: Providing Feedback for Pharmacists Improved Care for Veterans With Heart Failure

Findings from the PHARM-HF study, presented today as late-breaking science at the American Heart Association (AHA) 2024 Scientific Sessions, demonstrate that pharmacists in the Veterans Health Administration (VHA) System who received feedback on their patients’ heart failure medication rates, in addition to educational tools and targeted information, increased the frequency at which they managed heart failure and adjusted these medications.¹

Clinician holding a human heart replica | Image credit: © MR. INVINCIBLE | stock.adobe.com

Heart failure presents a significant public health burden and is expected to affect more than 8 million adults in the US by 2035, according to data from the AHA.² As this burden grows, so does the role for pharmacists in caring for this patient population. By providing medication reconciliation, educating patients on their condition and medications, and providing collaborative medication management, pharmacists have been shown to positively influence patient outcomes, including decreased hospitalizations and readmissions.³

One study, which reviewed peer-reviewed clinical trials, descriptive studies, and review articles, found that patients with heart failure require complex medication regimens in addition to lifestyle modifications and close follow-up from their care team. As part of a multidisciplinary health care team, pharmacists can take on various roles, particularly during transitions in care.³

Within the VHA System, primary care pharmacists are embedded in primary care panels and work alongside primary care physicians and nurses to optimize medication management for patients.¹

“In the VHA, primary care pharmacists can provide medication counseling, necessary monitoring, and they can independently prescribe indicated therapies,” said lead study author Alexander Tarlochan Singh Sandhu, MD, MS, a cardiologist specializing in heart failure at Stanford University in Palo Alto, California, in a news release. “They are empowered to identify individuals who would benefit from guideline-recommended treatments that are not being prescribed, such as heart failure medical therapy, and permitted to contact the patients to initiate therapy.”¹

Before the study period, the pharmacists averaged 2 patient visits per month that included heart failure care, as well as 0.4 patient visits per month that included adjusting a heart failure medication.¹

During the study evaluation period between January and May 2024, 120 primary care pharmacists responsible for more than 7000 heart failure patients were randomly assigned to 1 of 3 study groups. In the control group, participants received educational materials about treatment protocols, monthly webinars, and a database of frequently asked questions about heart failure management. In the audit and feedback group, pharmacists received educational materials as well as monthly audit and feedback emails nudging heart failure medication management. Finally, a third group of pharmacists received educational materials, monthly audit and feedback emails, plus targeted information listing patients with heart failure who had the potential for improvement with their medication regimen.¹

Preliminary findings presented today showed that both intervention groups had increases in the frequency of heart failure management. Pharmacists who were audited and received feedback had an additional significant increase in the frequency in which they managed patients with heart failure, with 1.2 more visits per month and more heart failure medication adjustments. However, adding access to patient-specific information did not result in any improved outcomes.¹

Study authors noted that receiving a monthly audit and feedback emails led to a small but significant increase in the frequency of prescribing a mineralocorticoid receptor antagonist medication. Historically, this class of medications is the most under-prescribed component of heart failure medication therapy.¹

“We found that when pharmacists participated in the audit and feedback group, they were more likely to identify patients who would benefit from medication adjustment, set up new appointments with patients to adjust heart failure medications, and adjust heart failure medication therapy during appointments, thus potentially leading to improved heart failure management and better patient outcomes,” Sandhu said.¹

REFERENCES

1. Giving pharmacists feedback improved care for veterans with heart failure. News release. American Heart Association. November 16, 2024. Accessed November 16, 2024. https://newsroom.heart.org/news/giving-pharmacists-feedback-improved-care-for-veterans-with-heart-failure?preview=693e&preview_mode=True

2. Cardiovascular Disease: A Costly Burden for America. American Heart Association and American Stroke Association. Accessed November 16, 2024. https://www.heart.org/-/media/Files/Get-Involved/Advocacy/Burden-Report-Consumer-Report.pdf

3. Cheng JWM. Current perspectives on the role of the pharmacist in heart failure managmement. Integr Pharm Res Pract. 2018;7:1-11. doi:10.2147/IPRP-S137882