February Marks American Heart Month

In February, the universal symbol of a heart goes beyond its connection to Valentine’s Day. February marks the beginning of American Heart Month, aiming to heighten awareness about cardiovascular health and promoting heart-healthy lifestyles. Pharmacists play a critical role every day throughout the year and especially during this month as they contribute significantly to their patients' healthy hearts through educational activities, medication safety management, and clinical pharmacy practice.

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At University of Pittsburgh Medical Center (UPMC) Presbyterian, home to the UPMC Heart and Vascular Institute (HVI), pharmacists are integral members of multidisciplinary teams dedicated to caring for patients with cardiovascular disease. Contributions that they make play a pivotal role in establishing the HVI as a leading global center for comprehensive cardiovascular care. The impact of cardiology pharmacists extends beyond the traditional bounds of the pharmacy. Their expertise is brought to the forefront of the decision-making process, actively engaging in interdisciplinary rounds, consultations, and discussions with health care providers. This collaborative approach ensures a holistic patient care strategy, integrating each professional's skills and expertise.

Inpatient pharmacists are decentralized to locations directly on the cardiac care units and are optimally positioned to provide comprehensive pharmacy services to physicians, nurses, patients, and caregivers. One essential task involves conducting a thorough prospective review of inpatient profiles. This comprehensive assessment is designed to ensure that all medications are not only prescribed accurately but are also tailored to the specific nuances of each patient's characteristics, such as weight, renal function, and hepatic function. Recognizing the impact of these vital systems on drug metabolism and clearance is essential for preventing adverse events and optimizing therapeutic cardiovascular outcomes.

In collaboration with their providers, patients with cardiovascular disease may experience dose and medication changes between inpatient admissions and office visits. With that knowledge, pharmacists strive to capture a comprehensive view of each patient at each touch point. This encompasses not only their current medications and doses, but also vital information such as heart rate, blood pressure, response to diuretic doses through urine output or weight measurements, any fluid or dietary restrictions, and reported modifiable risk factors.

During the admission process, the patient’s medication adherence and understanding of their disease state(s) is evaluated. This often involves discussions with the patient that lead to further medication reconciliation and intervention by pharmacists who then engage in discussion with the physician regarding recommendations on further medication optimization.

Concomitant medications and existing disease states add layers of complexity to inpatient care. The pharmacist's daily monitoring involves a thorough assessment of potential drug-drug interactions and the impact of medications on existing medical conditions. This proactive approach helps mitigate risks, ensuring that the patient's treatment plan remains cohesive and effective. Beyond the technical aspects of medication management, inpatient cardiology pharmacists play a crucial role in ensuring patients are medically optimized according to guideline-directed medical therapy. Staying ahead of the latest clinical guidelines and evidence-based practices, pharmacists collaborate with health care teams to align treatment plans with established standards. This commitment to guideline-directed care enhances the quality of patient management and contributes to positive long-term outcomes.

Patient allergies and previous adverse effects to medications are important to consider when prescribing medications to manage heart health. If there are any adverse drug reactions, those are documented in patients’ medical records and appropriately reported to other agencies. Documentation of patient reactions can help guide decision making in the future for safe patient care.

Pharmacists are continually reviewing medications changes occurring during the admission with patients and caregivers. Ensuring that the medications prescribed are affordable and accessible, and providing education on what to expect and adverse effects to look out for are highlighted.

Cardiology pharmacists play a pivotal role in facilitating the transitions of care process during patient discharge from the hospital. This involves addressing various medication-related aspects to ensure patients possess a comprehensive understanding of their prescribed medications. Discharge points cover crucial information such as the purpose, duration, administration points, potential adverse effects, and follow-up/monitoring guidelines for each medication. To streamline this educational process, UPMC Presbyterian Hospital has implemented the EPITOME (Enduring Pharmacy Interventions to Optimize Medication Education) II program. This program facilitates the ordering and dispensing of medications by the pharmacy, with nurses utilizing medication information cards or pharmacy teams meeting high-risk patients for counseling. Nurses then administer medications, ensuring a seamless transition for patients.

In the broader transitions of care process, steps include verifying the patient's discharge status, comparing current medication lists to home medications, providing discharge medication counseling, assessing the need for home medication refills, addressing patient concerns and questions, and documenting interactions in the electronic health record for comprehensive patient care.

Work does not stop once patients leave the hospital. Patients discharged from general cardiology units receive a follow-up phone call within 24 to 48 hours to address any questions or concerns, and pharmacists are ready to help should there be a need around medication conversations. Furthermore, UPMC Presbyterian has an Advanced Heart Failure Discharge Clinic, aiming to meet with patients within 1 week of discharge. During the visit, the initial 20 minutes are dedicated to a pharmacist-conducted medication history interview and reconciliation. The pharmacist shares their findings and recommendations with a nurse practitioner who then sees the patient. Patients may also be referred to the Medication Optimization Clinic upon discharge. This clinic operates via telemedicine with a focus on titrating medications to target doses in the outpatient setting, ensuring continuous and personalized care beyond the hospital stay.

At UPMC, the pharmacy team loves celebrating the month of February to give an extra focus to spreading awareness and education about cardiovascular disease. The pharmacy team at UPMC Presbyterian participates in a local Heart Walk hosted by the American Heart Association (AHA) to help raise awareness and funding. But no matter what the month, pharmacists’ dedication to heart health remains the same. Education is provided to staff relating to heart health with activities, games, and additional content posted on pharmacy department message boards. Encouraging people to reclaim control of their mental and physical well-being, focus on staff wellbeing, and supporting a healthy lifestyle for the pharmacy teams as well as patients aligns well with the AHA campaign.

The integral role of pharmacists in cardiovascular care is evident throughout the year and takes on heightened significance during this month. The dynamic environment of UPMC Presbyterian is testament to these efforts and the commitment of cardiology pharmacists going beyond traditional roles to benefit patient outcomes. As the complexities of cardiovascular care are navigated, the collaborative efforts shared continue to shape positive and enduring outcomes for patients and their well-being.