HF death, hospitalization not affected by pharmacist consultation
MedWire News: A pharmacist-led primary care intervention modestly improved cardiovascular medication prescription, but did not significantly improve rates of death and hospitalization in patients with heart failure (HF), show findings from the HOOPS trial.
"Even though pharmacists didn't cut the number of deaths or hospitalizations from HF, the results appear to strengthen the case for optimizing HF drugs," said the lead author Richard Lowrie (University of Glasgow, UK), who presented the results at the American Heart Association Scientific Sessions in Orlando, Florida. "Other studies have shown these drugs can reduce HF hospitalizations."
The Heart failure and Optimal Outcomes from Pharmacy Study (HOOPS) was set up to test the hypothesis that pharmacist-led collaborative review and revision of pharmacological treatment can improve outcomes in patients with HF, as suggested by meta-analyses of previous studies.
A total of 2164 patients with left ventricular systolic dysfunction from 174 practices in the Glasgow area of Scotland were enrolled in the study and were followed up for 4.7 years on average after being randomly assigned to pharmacist intervention (87 practices; n=1090) or usual care (87 practices; n=1074).
The intervention involved non-specialist pharmacists working with general practitioners to optimize patient treatment for left ventricular systolic dysfunction. The pharmacists had a 30-minute interview with all the patients in the intervention group.
The patients were relatively well-treated for their condition at baseline, with 86% of patients in both groups being treated with an ACE inhibitor or ARB.
The team found that in patients not receiving either of these medications or a lower than recommended dose, treatment was initiated or dose increased in 33.1% of the pharmacist intervention group versus 18.5% of the usual care group during the follow-up period (p<0.001).
At the beginning of the study, 62% of the patients were receiving a beta blocker. More patients in the intervention group started or increased their dose of beta blocker over the study period, at 17.9% versus 11.1% (odds ratio=1.76; p<0.001).
Despite the increase in prescription of appropriate drugs, however, there was no significant difference between the two groups for the primary endpoint of all-cause death or HF hospitalization (hazard ratio=0.97, p<0.72).
"While our results show that the non-specialist pharmacist intervention is not that effective in reducing hospitalization or death rates, we did demonstrate the impact pharmacists have on getting patients on recommended HF drugs," commented Lowrie.
"This could be an important intervention in health systems with a low number of patients receiving recommended HF drugs," he added.
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By Helen Albert