Clinical Pharmacists Improve Outcomes Of Heart Failure Patients

March 30, 1998

ATLANTA -- Patients with progressive heart failure commonly take up to a dozen medications, see numerous physicians in and out of the hospital and often suffer from other disorders. A Duke University Medical Center study shows that the addition of a clinical pharmacist to a multi-disciplinary heart failure team improves the outcomes for these chronically ill patients.

The Duke researchers said the broad use of clinical pharmacists in the management of heart failure appears to save money by reducing the frequency of hospital re-admissions and allows cardiologists more time to devote to the non-pharmaceutical aspects of patient care.

More than 3 million Americans suffer from the debilitating effects of heart failure, with 400,000 new cases diagnosed each year. It is estimated that one-third of the hospital admissions of these patients are due to non-compliance with medication and dietary regimens, the researchers said.

"This is the first randomized trial to measure the effects of a clinical pharmacist in the management of heart failure patients," said clinical pharmacist Wendy Gattis, who has a doctorate in pharmacy. "These patients have a chronic disease that can be managed with appropriate medications, such as ACE inhibitors. Pharmacists can be useful in helping optimize drug therapy for these patients, many of whom are taking as many as a dozen different medications, both prescription and over-the-counter.

"For that reason, in order to make optimal use of these medications, it is essential that we know about all the different interactions between them," she said. "As a clinical pharmacist, we provide this information to the team as well as the patient. We also follow-up with patients, to ensure they aren't having any side effects or adverse reactions."

Duke cardiologist Dr. Christopher O'Connor, a member of the research team, said he believes the use of clinical pharmacists "will ultimately prove to be cost-effective in the long run. The average cost per hospitalization for a heart failure patient is approximately $7,000. If we can reduce the rate of rehospitalization, the savings should add up quickly."

Gattis prepared the results of the Duke research for presentation Monday at the 47th annual scientific session of the American College of Cardiology.

The researchers followed 181 patients in Duke's cardiology clinic. All were seen by a team made up of cardiologists, physician assistants and nurses. In addition, 90 of the patients were also seen by a clinical pharmacist. Patients were followed for six months.

The group with the clinical pharmacist intervention experienced three deaths and one rehospitalization, while the non-intervention group reported five deaths and 11 rehospitalizations. While differences in deaths were not statistically significant, there was a significant reduction in the number of re-admissions to the hospital, the researchers concluded.

Patients in the intervention group were more likely to be on a higher dose of ACE-inhibitors, a class of drugs which is very important in reducing future events and deaths for heart failure patients, Gattis said.

"Clinical pharmacists have been extremely helpful -- both for physicians and patients -- in evaluating the side effects of drugs and their interactions with each other," O'Connor said.

"The types of interactions are very complex," he continued. "Heart failure patients are commonly on six to seven different medications, as well as another two to three over-the-counter drugs. Having a clinical pharmacist on hand to sort out these interactions lets me focus on other areas of treatment, including psychological and social issues, family dynamics, and decision-making on invasive surgical procedures, including bypass or transplantation."

As a group, heart failure patients often have other medical problems and are seen by other physicians, who also may prescribe medications of their own. And since most patients are increasingly being managed on an out-patient basis, having a clinical pharmacist assist physicians in prescribing the best combination of drugs for heart failure and monitoring patient compliance to make sure patients are taking their medications can play an important role in reducing rehospitalizations, Gattis said.

Joining Gattis and O'Connor in the study, which was funded by the Duke Clinical Research Institute and Duke's Division of Cardiology, were Dr. Vic Hasselblad, Dr. David Whellan and Rhonda Larsen.
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Duke University Medical Center

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