Pharmacist-led heart clinics effective
Pharmacists used dose titration protocols |
Cardiac clinics led by pharmacists can improve the proportion of patients taking the recommended treatment and reduce symptoms of heart failure. So say researchers who report results from a pharmacist-led heart failure clinic in London (European
Journal of Heart Failure 2005;7:405).
Over a three-year period, 265 patients with heart failure were referred
to clinics set up in Newham Healthcare Trust and Barts and The London
NHS Trust. The clinics were led by a cardiac pharmacist and staffed by
specialist nurses. Management guidelines for the initiation of treatment
via patient group directions were established, and the clinics were supervised
by a consultant cardiologist. Protocols were also established for the
up-titration of treatment and the measurement of biochemical markers.
The researchers report that out of the 234 patients that had at least
one follow-up visit, 127 patients (57 per cent) were either not receiving
a key therapeutic agent or were missing a recommended drug on presentation
at the clinic. This was reduced to 25 patients (11 per cent) after a
two-year follow-up. Significant up-titration of dose was seen for patients
on beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin
receptor blockers. These treatment interventions were associated with
reductions in heart rate and systolic blood pressure.
The researchers report a reduction in the proportion of patients with
moderate or severe heart failure, as classified by the New York Heart
Association, and say that no deterioration of renal function or adverse
effects on electrolytes were seen. |
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