Impact of a clinical pharmacist in an outpatient heart transplant clinic

Abstract

Introduction: Pharmacotherapy-related prevention of cardiac allograft vasculopathy, optimal immunosuppression regimens, and metabolic management are essential for promotion of graft survival in heart transplant recipients.Methods: Following the addition of an ambulatory clinical pharmacist to the heart transplant team at an academic medical center in January 2018, we sought to assess the impact of pharmacist integration on pharmacotherapy-related clinical outcomes including goal blood pressure, diabetes control, appropriate statin and aspirin utilization, tacrolimus variability, and patient and graft outcomes at 1 year postheart transplant via a retrospective pre-post analysis.Results: Fifty-nine heart transplant recipients were included. At 1 year, the pharmacist cohort had a higher percentage of heart transplant recipients at goal blood pressure (93.1 vs 71.4%, P = .03), on a statin (96.7 vs 67.9%, P = .004), and with fewer 1 year hospital readmissions (55 vs 28, P = .03); no significant differences in HbA1c, aspirin use, tacrolimus level variability, or patient and graft survival were observed.Discussion: This analysis suggests that the integration of a pharmacist into the routine ambulatory care of heart transplant recipients is associated with improvement in several pharmacotherapy-related clinical outcomes.

National survey of transplant pharmacist ambulatory care practices

“…Furthermore, ambulatory clinical pharmacists have the potential to optimize pharmacotherapy‐related clinical outcomes. When compared with a nonpharmacist control cohort, a higher incidence of heart transplant recipients were at goal blood pressure (93.1% vs. 71.4%, p = 0.03), were on statin therapy (96.7% vs. 67.9%, p = 0.004), and had numerically fewer hospital readmissions (55 vs. 28, p = 0.03) 9 …”

“…Pharmacists providing care to SOT recipients in the ambulatory care setting have demonstrated value within the areas of medication safety, medication adherence assessment and improvement, and early posttransplant medication management 4–10 . A study by Cohen et al 6 evaluated the role of the SOT pharmacist in a renal transplant clinic to reduce medication errors.…”