Heart Failure Transitions of Care: A Pharmacist-Led Post-Discharge Pilot Experience

LaForest, Sharon; Gee, Julie; Pugacz, Adam; Piña, Ileana L.; Hoover, Danielle; Wenzell, Robert C.; Felton, Aubrey; Guttenberg, Eric; Ortiz, Jose

doi:10.1016/j.pcad.2017.08.005

Cited by 33 publications

(69 citation statements)

References 30 publications

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“…Previous studies have shown similar hold rates of BBs in general medicine and cardiology wards to what this study has found [22]. There have been previous quality improvement projects directed at nursing, physicians and pharmacists to attempt to improve prescription rates for BBs in heart failure patients [22][23][24][25]. Our future studies will include examining the hold rates of BB holding practices between different specialties such as cardiology, academic internal medicine, family medicine and hospitalists.…”

Section: Discussionsupporting

confidence: 68%

Effects of Holding Beta-Blockers on the Vital Signs of Heart Failure Patients

et al. 2021

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Background: Heart failure with reduced ejection fraction (HFrEF) is associated with recurrent hospitalizations and high mortality. Guideline-directed medical therapy (GDMT) reduces morbidity, mortality and re-admission rates. Despite the evidence, less than 50% of patients with HFrEF are prescribed appropriate medical therapy. When hospitalized patients have these medications discontinued on admission or during hospitalization, they are less likely to have them restarted on discharge. The goal of this study was to determine the incidence of disruption of beta-blocker (BB) therapy during hospitalization for HFrEF patients admitted to an academic tertiary referral hospital. Methods:We conducted a retrospective study in a single teaching hospital over the course of 1 year, and utilized data queried from the electronic medical record (EPIC) database. Inclusion criteria were met by patients with an ICD-10 code diagnosis of heart failure, left ventricular ejection fraction less than 40% and BB prescription prior to admission. Additional information noted included age, sex, vital signs throughout the admission and dates where BB was not given for a full 24-h period. Patients in the intensive care unit (ICU) were excluded due to uncertainty of their hemodynamics. Data were extracted from the electronic medical record database and analyzed through Python, Microsoft Excel and RStudio. The incidence of BB disruption during hospitalization was defined as a 24-h period where no BB was administered. Blood pressure (BP) and heart rate (HR) levels were compared between patients who received BB and patients who had a disruption in their BB. Measurements were also obtained to assess whether a correlation exists between holding BB therapy and time of the year, age, or sex.Results: Between January 2018 and January 2019, 780 patient encounters met inclusion criteria for the study. Patients who were continued on BB therapy had an average BP of 120.8/68.7 mm Hg and an HR of 82.4 bpm on days they received their BB. Patients who had a disruption of BB therapy had an average BP of 117.7/67.6 mm Hg and an HR of 88.6 bpm on the days of the disruption (P < 0.001). There was no association between holding BB and age, sex, or time of year.Conclusions: This study showed that in an academic tertiary referral center, patients with HFrEF who are not in an ICU have a 23% chance of not receiving their recommended BB therapy for 24 h. While the differences measured for BP and HR are statistically significant, they are not clinically significant.

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Section: Discussionsupporting

confidence: 68%

Effects of Holding Beta-Blockers on the Vital Signs of Heart Failure Patients

et al. 2021

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“…Prior studies from Western countries that have evaluated post-discharge programs designed to reduce rehospitalization and increase survival rates of CHF patients have demonstrated the effectiveness of such interventional strategies [6][7][8][9]. Interestingly and importantly, studies of nurse-led programs of care for CHF also confirmed these benefits, suggesting that nurses can play positive roles in the management of CHF patients after discharge [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure

You

Wang²,

et al. 2020

Med Sci Monit

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Departmental sources Background: The aims of the present study were to determine whether a nurse-led program of care can improve medication adherence, quality of life (QoL), rates of rehospitalization, and all-cause mortality for chronic heart failure (CHF) patients. Material/Methods: CHF patients were randomly assigned into either a control group or an intervention group. At 12 weeks, patients were followed up to evaluate the rate of medication adherence, QoL (as assessed by SF-12 physical and mental component score [PCS and MCS]), rehospitalization, and all-cause mortality. Results: We recruited 152 patients. No significant differences in demographics, comorbidities, CHF severity, or etiology at baseline were observed. At discharge, no significant differences in medications prescription, PCS (46 vs. 45), or MCS (55 vs. 56) were observed. However, at 12-week follow-up, compared to the control group, patients in the intervention group were more likely to keep on medications therapy, with a significantly higher use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker [73.8% vs. 59.7%], beta-blocker (62.5% vs. 51.4%), and aldosterone receptor antagonist (60% vs. 54.2%). Both PCS (35 vs. 40) and MCS (42 vs. 49) were also significantly lower in the control group versus the intervention groups (P<0.05). Patients in the control group had higher incident rate of rehospitalization (8.0% vs. 5.2% per person-week) than in the intervention group, with an incident rate ratio of 1.54 (95% confidence interval [CI]: 1.06-2.23). Conclusions: A nurse-led discharge program of care can be a cost-effective and feasible approach for management of CHF patients in China.

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“…In disease management, pharmacists educate and monitor medication therapy to achieve therapy goals over a period of time, make recommendations about drug therapy to providers, and may be able to directly initiate or change therapy under a collaborative practice agreement (depending upon each state’s scope of practice). Examples of conditions that pharmacists commonly manage include hypertension [49], heart failure [50], diabetes [51,52], and asthma [53,54].…”

Section: Array Of Value-added Pharmacist Servicesmentioning

confidence: 99%

Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services

Desselle

Moczygemba²,

Coe

et al. 2019

Pharmacy

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Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using appropriate theory-based paradigms. Many of the more important management theories for pharmacy services consider the “servicescape” of these services recognizing the uniqueness of each patient and service encounter that vary based upon health needs and myriad other factors. In addition, implementation science principles help ensure the financial viability and sustainability of these services. This commentary reviews some of the foundational management theories and provides a number of examples of these theories that have been applied successfully resulting in a greater prevalence and scope of value-added services being offered.

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Heart Failure Transitions of Care: A Pharmacist-Led Post-Discharge Pilot Experience

Cited by 33 publications

References 30 publications

Effects of Holding Beta-Blockers on the Vital Signs of Heart Failure Patients

Effects of Holding Beta-Blockers on the Vital Signs of Heart Failure Patients

Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure

Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services

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