Pharmacists Take the Lead When Monitoring Patients with Multisensor Implantable Cardioverter Defibrillators

Patients with heart failure (HF) have a high rate of health care utilization in the US. Implantable cardioverter defibrillators (ICDs) are used for HF to reduce morbidity and mortality. ICDs help reduce hospitalizations using continuous remote monitoring, enabling prompt detection of treatment plan issues and necessary adjustments. For patients with ICDs, remote monitoring (RM) is the standard of care and pharmacist-managed HF monitoring has become an added layer of vigilance.

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Pharmacists from the Kaiser Permanente San Diego Medical Center clinical pharmacy service analyzed hospitalizations and emergency department (ED) visits, focusing on patients with HF and ICDs to determine the impact of pharmacist involvement in a remote monitoring model. Results of the study were published in the February 2024 issue of the American Journal of Health-System Pharmacists.

The study, a retrospective chart review of hospitalizations and ED visits in patients who received an ICD with multisensor activation, followed patients through the 1-year pre-activation periodand 1-year post-activation period.

Findings showed that pharmacists frequently communicated with patients to implement complex plans. Pharmacists also counseled on HF education, particularly salt and fluid restriction. This approach enabled pharmacists to concentrate on high-alert patients who required medication adjustments and therapy optimization.

The pre-activation period had a higher rate of hospitalization and ED visits with longer length of stay for all-cause hospitalizations. A significant portion of alerts focused on congestion relief and volume management, prompting actions such as initiation, adjustment, or changes in diuretic therapy. All-cause hospitalizations, HF-related hospitalizations, and ED visits improved significantly.

Medication optimization was higher in the post-activation period. Duration of hospital stay showed no significant difference for both all-cause and HF-related hospitalizations. Overall, pharmacists were responsible for managing most patients remotely. Access to cardiology specialty care increased for additional patients who required in-clinic follow-up visits.

This study showed that a pharmacist-led remote monitoring model using multisensor diagnostic–capable ICD for medication management significantly reduced the average number of all-cause and HF-related hospitalizations and all-cause ED visits per patient. The study authors recommend medical centers consider similar pharmacist-led programs for HF patients to maximize benefit in reduction in the number of hospitalizations and ED visits.

Reference

Audrey Kwon, Phuong Denomme, Impact of a pharmacist-managed remote heart failure program in patients with a multisensor-capable implanted device, American Journal of Health-System Pharmacy, 2024;, zxae028, https://doi.org/10.1093/ajhp/zxae028