Pharmacist- and Nurse-Led Medical Optimization in Heart Failure: A Systematic Review and Meta-Analysis

Zheng, Jimmy; Mednick, Thomas; Heidenreich, Paul A.; Sandhu, Alexander T.

doi:10.1016/j.cardfail.2023.03.012

Cited by 21 publications

(18 citation statements)

References 58 publications

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“…Medications of interest within the 80 reviews included in our umbrella review were: statins (n=10),25–34 antihypertensives (n=38),35–72 and statins and antihypertensives (n=34) 73–104. Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61.…”

Section: Resultsmentioning

confidence: 99%

“…Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61. Of the reviews synthesising quantitative evidence evaluating interventions, interventions focused on: enhancing patient adherence to medication as prescribed (n=57),25 30 32–35 37–41 43–46 48 49 51 53 54 56 57 59 62 63 65–71 73–81 86 87 89–96 98–103 105 deprescribing a prescribed medication (n=6)36 46 72 80 88 93 or optimising the prescribing of medication to meet the needs of the patient (n=13) 26 28 29 38 52 64 71 84 85 87 90 100 106. Three of these reviews were judged by reviewers to have dual aims 71 87 90.…”

Section: Resultsmentioning

confidence: 99%

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What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

Shaw,

Briscoe,

Nunns

et al. 2024

BMJ Open

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ObjectivesWe aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication.DesignSystematic umbrella review and evidence and gap map (EGM).Data sourcesEight bibliographic databases (Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Health Management Information Consortium, MEDLINE ALL, PsycINFO, Conference Proceedings Citation Index—Science and Science Citation Index) were searched from 2010 to 11 August 2020. Update searches conducted in MEDLINE ALL 2 August 2022. We searched relevant websites and conducted backwards citation chasing.Eligibility criteria for selecting studiesWe sought systematic reviews of quantitative or qualitative research where adults 16 years+ were currently receiving, or being considered for, a prescription of statin or antihypertensive medication. Eligibility criteria were applied to the title and abstract and full text of each article independently by two reviewers.Data extraction and synthesisQuality appraisal was completed by one reviewer and checked by a second. Review characteristics were tabulated and incorporated into an EGM based on a patient care pathway. Patients with lived experience provided feedback on our research questions and EGM.ResultsEighty reviews were included within the EGM. The highest quantity of evidence focused on evaluating interventions to promote patient adherence to antihypertensive medication. Key gaps included a lack of reviews synthesising evidence on experiences of specific interventions to promote patient adherence or improve prescribing practice. The evidence was predominantly of low quality, limiting confidence in the findings from individual reviews.ConclusionsThis EGM provides an interactive, accessible format for policy developers, service commissioners and clinicians to view the systematic review evidence available relevant to optimising the prescribing of statin and antihypertensive medication. To address the paucity of high-quality research, future reviews should be conducted and reported according to existing guidelines and address the evidence gaps identified above.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

Shaw,

Briscoe,

Nunns

et al. 2024

BMJ Open

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“…The use of specially trained clinical pharmacists and advanced practice practitioners has been shown in multiple studies to effectively and safely optimize GDMT for larger cohorts of patients with HFrEF. 7 In our cost-effectiveness study of a model-intensive GDMT optimization program, we showed that an approach of using clinical pharmacists under the supervision of cardiologists would be highly cost-effective. In sensitivity analysis, despite increasing the cost of the program, it remained highly cost-effective with ICERs only reaching >$50 000 in the HIC cohorts if the estimated cost of the program exceeded the base case by >10-fold.…”

Section: Clinical Trial Modelmentioning

confidence: 87%

“…9,28 Moreover, in institutions lacking clinical pharmacists or clinic space, intensive GDMT optimization programs have effectively used alternative advanced practice practitioners, such as nurse practitioners and physician assistants, and telehealth delivery models to care for patients with HF. 7 Intensive GDMT optimization programs are not only highly cost-effective from a population standpoint but also viable strategies for institutions and payers to increase the quality of care for patients with HFrEF without heavy financial investment.…”

Section: Clinical Trial Modelmentioning

confidence: 99%

“…STRONG-HF was a multicenter trial with a relatively small number of patients at each site, but single-center GDMT titration programs using pharmacists and advanced practice practitioners have been shown to be effective and represent a feasible solution to increase the scale and reach of GDMT titration programs. 7 To date, the cost-effectiveness of such programs has not been evaluated. We sought to estimate the cost-effectiveness of an intensive GDMT titration program using efficacy estimates from the STRONG-HF trial from a US health care sector perspective.…”

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confidence: 99%

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Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients

Dixit,

Parikh,

Ziaeian

et al. 2023

Circ: Heart Failure

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BACKGROUND: The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown. METHODS: Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines–HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled. RESULTS: An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively. CONCLUSIONS: An intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.

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Reply to ‘The pharmacist ally in heart failure: Useful when involved’

Beavers,

Bhatt,

Gotter

2024

European J of Heart Fail

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Pharmacist- and Nurse-Led Medical Optimization in Heart Failure: A Systematic Review and Meta-Analysis

Cited by 21 publications

References 58 publications

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients

Reply to ‘The pharmacist ally in heart failure: Useful when involved’

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