Pharmacist directed home medication reviews in patients with chronic heart failure: A randomised clinical trial

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Abstract

Background

Chronic heart failure (CHF) accounts for significant morbidity, mortality and health expenditure. Furthermore, patients with CHF are often on numerous pharmacological agents for their comorbidities. The objective of this study was to determine whether a pharmacist directed home medication review intervention had positive effects on CHF patient outcomes.

Methods

A total of 120 patients hospitalised for CHF were randomised to receive a pharmacist directed post-discharge home medication review (n = 64, 53.3%) or standard care (n = 56, 46.7%). Participants were followed for 6 months. Primary outcomes were death, CHF hospitalisation and length of hospital stay.

Results

There were no between group differences in mortality (hazard ratio = 1.41, 0.50 to 3.97; P = 0.514) or CHF hospitalizations (incidence rate ratio [IRR] = 1.74 95% CI: 0.85–3.60 P = 0.131) over the 6 month follow-up period. Days of hospital stay for CHF exacerbations in the 6 month follow-up were significantly greater in the intervention group (IRR = 2.34 95% CI: 1.80–3.05 P = 0.000).

Conclusions

Post-discharge pharmacy directed home medication review appeared to have no effect on mortality and health care utilisation above that achieved with standard care. The post-acute management of CHF must be a collaborative multi-disciplinary effort by the health care team as it is the additive effect of interventions that are most effective.

Section snippets

Patient population

Participants were recruited from a public teaching hospital in Melbourne, Australia. Eligible patients had a hospital length of stay of at least 48 h, were on four or more medications and met the Framingham Criteria for CHF [15]. Patients were excluded who had planned discharge to a residential aged care facility or another hospital, were oncology patients that required frequent admissions for chemotherapy and radiotherapy, were receiving renal dialysis or whose place of residence was outside

Results

Of the 120 patients included in the study, 56 were randomly allocated to the usual care group (Fig. 1). A large proportion of patients were non-English speaking, of New York Heart Association (NYHA) class II and had several comorbidities. Age, comorbidities, baseline length of stay and number of medications on discharge in both groups were comparable. There was a significantly higher proportion of people with NYHA = 1 in the control group (P = 0.0346) than the intervention group.

Discussion

The results of this study indicate that a pharmacist directed home-based intervention for people recently discharged from hospital with CHF had no effect on health care utilisation, mortality and health related quality of life above that achieved with standard care. These findings support those of the most recent systematic review meta-analysis results which found no significant effect with pharmacist-directed interventions for people with CHF on mortality (OR = 0.92; 95% CI: 0.62–1.38),

Conclusions

Systematic reviews suggest that pharmacists play an important role in the successful management of high-risk patients with CHF; however in isolation, post-discharge pharmacist directed intervention does not offer improvements in patient outcomes above usual-care. Non-pharmacological therapies represent an important component of successful management of CHF and as such multi-disciplinary collaborative post-discharge care is the preferred intervention.

Acknowledgement

Thanks are extended to Maria Murphy for her contribution to the study.

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [26].

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    Funding for this study was provided by the Victorian Department of Human Services.

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