Medications are a cornerstone of treatment of heart failure (HF) with reduced ejection fraction, thus pharmacists are valuable members of the multidisciplinary team approach to long‐term patient management. As pharmacists' scope of practice has expanded, growing evidence shows an evolution in pharmacists' roles in the care of patients with HF. To synthesize the literature describing implementation of pharmacist‐led medication titration and clinical assessments on outcomes in ambulatory patients with HF. MEDLINE, Embase, and Cochrane Controlled Register of Trials were searched from 2007 to March 18, 2020. English language articles that evaluated implementation of pharmacist‐led medication titration in ambulatory patients with HF. Studies with interventions that involved pharmacists prescribing to initiate, modify, or discontinue medications with independent authority or under a collaborative practice agreement were considered. Ten retrospective studies from 718 identified articles were included. All studies incorporated pharmacist‐led guideline‐directed medical therapy (GDMT) titration, two with independent pharmacist prescribing in a multidisciplinary HF clinic, and seven in a pharmacist‐only clinic. Patients were referred from both inpatient and outpatient settings and had an average reported range of 1–5.7 visits with pharmacists. While four studies exclusively included patients with HF and ejection fraction below 45%, the mean ejection fraction of all included patients ranged from 20% to 42%. Four studies showed an increased proportion of patients on GDMT or target doses after pharmacist prescribing. Four out of six studies showed a significant decrease in all‐cause hospitalizations and one of two studies reported a significant decrease in all‐cause mortality rate with intervention. This study found that pharmacist‐led medication optimization increased the use of GDMT in ambulatory patients with HF, and may be associated with fewer hospitalizations and deaths. Future randomized controlled trials should evaluate the impact of adding pharmacist‐led HF medication optimization to standard of care on clinical outcomes.

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Background: Poor prescribing and incomplete medication administration have been linked to increased lengths of hospitalization for patients with Parkinson disease. The Institute for Safe Medication Practices (ISMP) has recommended that patients with Parkinson disease receive a pharmacy consultation within 2 h of admission to hospital. Objectives: To examine whether the time for a pharmacy team member to obtain a best possible medication history (BPMH) was associated with administration-related medication errors. The primary outcome was the proportion of doses with a medication error during a patient’s admission in relation to the time to completion of the initial BPMH by a registered pharmacist (RPh) or registered pharmacy technician (RPhT). The secondary objective was to compare the proportion of doses with a medication error in relation to whether the BPMH was completed by an RPh or an RPhT. Methods: This retrospective chart review involved patients with Parkinson disease who were admitted to the medicine services at London Health Sciences Centre from September 30, 2014, to September 30, 2018. Patients were included if they had Parkinson disease and a medication regimen that included levodopa-carbidopa. For all patients, an RPhT or RPh conducted the initial BPMH or updated the BPMH. Pearson correlation analysis was used to determine whether a correlation existed between administration-related errors and completion of the BPMH by a pharmacy staff member. Results: A total of 84 patients with 104 admissions were included. There was no significant correlation between the time to completion of the initial BPMH by a pharmacy team member and the proportion of doses with medication errors (p = 0.32). Although RPhTs completed the BPMHs more quickly than RPhs (p < 0.001), there was no significant difference between pharmacy team members in terms of the proportion of doses with medication errors (p = 0.86). Conclusions: Completing a BPMH within 2 h of a patient’s admission, as per the ISMP recommendation, is unlikely to affect administration-related medication errors, given that no correlation was identified. Expediting BPMH without addressing other factors is insufficient, and initiatives are required to improve the medication administration process. RÉSUMÉ Contexte : La mauvaise prescription et l’administration incomplète de médicaments ont été liées à une augmentation de la durée du séjour à l’hôpital des patients atteints de la maladie de Parkinson. L’Institute for Safe Medication Practices (ISMP) a recommandé que les patients atteints de la maladie de Parkinson obtiennent une consultation en pharmacie dans les 2 heures après leur admission à l’hôpital. Objectifs : Vérifier si le temps d’attente pour l’obtention, par un membre de l’équipe de la pharmacie, du meilleur schéma thérapeutique possible (MSTP) était associé ou non à des erreurs de médication liées à l’administration. Le résultat principal portait sur la proportion des doses comportant une erreur de médication lors de l’admission d’un patient par rapport au temps nécessaire à un pharmacien ou à un technicien en pharmacie autorisés pour réaliser le MSTP initial. L’objectif secondaire visait à comparer la proportion des doses comportant une erreur de médication entre un MSTP réalisé par un pharmacien autorisé et un MSTP réalisé par un technicien en pharmacie autorisé. Méthodes : Cet examen rétrospectif des dossiers impliquait des patients atteints de la maladie de Parkinson ayant été admis aux services de médecine au London Health Sciences Centre entre le 30 septembre 2014 et le 30 septembre 2018. Les patients pouvaient participer à l’étude s’ils avaient la maladie de Parkinson et qu’ils suivaient un traitement médicamenteux comprenant du lévodopa-carbidopa. Un pharmacien autorisé ou un technicien en pharmacie autorisé réalisait ou actualisait le MSTP initial de tous les patients. La corrélation de Pearson a servi à déterminer s’il existait une corrélation entre les erreurs liées à l’administration et la réalisation du MSTP par un membre du personnel de la pharmacie. Résultats : Au total, 84 patients correspondant à 104 admissions ont été inclus dans l’étude. Il n’y avait aucune corrélation importante entre le moment de la réalisation du MSTP initial par un membre du personnel de la pharmacie et la proportion des doses comportant des erreurs de médication (p = 0,32). Bien que les techniciens en pharmacie autorisés aient terminé plus rapidement leur MSTP que les pharmaciens autorisés (p < 0,001), aucune différence importante n’a été notée entre les membres du personnel de la pharmacie en termes de proportion des doses et d’erreur de médication (p = 0,86). Conclusions : Il est peu probable que la réalisation d’un MSTP dans les 2 heures après l’admission d’un patient, conformément à la recommandation de l’ISMP, ait une influence sur les erreurs de médication liées à l’administration, vu qu’aucune corrélation n’a été décelée. Précipiter la réalisation du MSTP sans aborder les autres facteurs ne suffit pas et des actions sont nécessaires pour améliorer le processus d’administration des médicaments.

Heart failure (HF) is a complex clinical syndrome involving structural and/or functional abnormalities of the heart. Heart failure is often classified based on left ventricular ejection fraction, which serves as a predictor of mortality. The majority of the data supporting disease-modifying pharmacological therapies are from patients with reduced ejection fraction (less than 40%). However, with the recent results from the sodium glucose cotransporter-2 inhibitor trials, there is renewed interest in identifying potential beneficial pharmacological therapies. This review focuses on and includes pharmacological HF therapies across the spectrum of ejection fraction, providing an overview of the novel trials. We also examined the effects of the treatments on mortality, hospitalization, functional status, and biomarker levels to further investigate the interplay between ejection fraction and HF.