Evaluation of Pharmacist Impact Within an Interdisciplinary Inpatient Heart Failure Consult Service

Abstract

Background: Heart failure (HF) is highly prevalent in the Veterans Affairs (VA) health care system and the leading cause of hospital discharges in the VA. Despite guideline-specific recommendations of drug therapy, many patients are not on optimal medication regimens. Objective: To examine and quantify pharmacist impact in an interdisciplinary HF consult (IC) service on increasing use of guideline-directed medical therapy (GDMT). The 30-day readmission rates before and after the implementation of an IC service are reported. Methods: This was a single-center retrospective analysis of veterans admitted with a HF diagnosis between August 2008 and August 2015 in 2 distinctive cohorts: pre-IC (August 2008 to November 2011) and IC (November 2011 to August 2015). Results: Four-hundred patients were included, with 200 in each cohort. All-cause readmissions at 30 days were not different between pre-IC and IC groups: 33.5% versus 28.5%, respectively. Secondary outcomes of HF readmission and 1-year mortality were not different between groups. Significant increases in medication use rates were observed from admission to discharge in both cohorts; however, greater increases were observed in the IC group in which the pharmacist role was clearly defined in recommending GDMT optimization, especially in patients with HF with reduced ejection fraction. Conclusion and Relevance: Although the implementation of an IC service did not significantly change 30-day readmission rates, increases in GDMT use are evident with increased pharmacist involvement. Longer-term outcomes associated with this intervention warrant future investigation.

Cost of Heart Failure In-Patient in Saudi Arabia: Role of Heart Failure Multidisciplinary Program

“…They gave proper education and counseling about contraindications, intolerance, or other reasons to HF team in collaboration with the patients and caregivers for not utilizing proper therapies [41]. problems and provide comprehensive, and timely responses to drug information requests as well as they document the source of scientifically valid information and advice regarding the safe, appropriate, and costeffective use of medicines and develop, review, and evaluates clinical guidelines for medications used in stated management protocol with GDMTs according to evidence, compliance with prescription during hospitalization and delivery of adequate patient education regarding medication use and follow-up, thereby improving the outcome of patients with HF [42,43].…”

Utilizing Pharmacist-Led Telehealth Services in Ambulatory Patients with Heart Failure

“…7 Several studies investigating the effect of pharmacists during in-person HF visits have demonstrated improvements in patients' selfmaintenance, self-management, and self-confidence behaviors, increased use in guideline-directed medical therapy, shorter time to necessary follow-up visits, and reduction in 30day mortality and hospital readmission. [8][9][10] Another method of delivering pharmacy services that has been shown to demonstrate a positive impact on patient care is telehealth. 7 In the outpatient setting, telehealth services allow the patient to have more accessibility to their provider by reducing the burden of in-person office visits.…”