Hospital Pharmacist
Vol 12 No 3 p86
March 2005

News summary

Pharmacists benefit heart failure patients

Pharmacist involvement in heart failure clinics benefits patients, according to a study reported in the latest issue of the European Journal of Heart Failure (2005;7:405–10).

The researchers analysed the care given to 234 patients with heart failure at specialist clinics at Barts and The London NHS Trust and Newham University Hospital NHS Trust, London, over three years. At the clinics, treatment is managed by pharmacists and nurses working in accordance with management guidelines and clinical protocols that enable them to initiate and manage drug treatments. Patients are referred to the clinics by GPs or hospital doctors and attend on average once a month.

Most of the patients (93 of whom had moderate to severe heart failure and 141 of whom had mild heart failure on referral to the clinic) saw their symptoms improve.

For example, 175 patients suffered from dyspnoea when they were first referred. Approximately one-third of these patients saw their symptoms disappear completely after being treated at the clinic. The number of patients with moderate or severe dyspnoea fell by about two-thirds, from 66 to 23. Similarly, 158 patients experienced fatigue when they were first referred. After treatment, this fell to 138 while the number of patients with moderate or severe symptoms fell by almost a quarter from 55 to 44.

Some patients saw their condition (and not just their symptoms) improve significantly following treatment. Almost half of those diagnosed with moderate or severe heart failure after referral were reassessed later and diagnosed with mild heart failure.

A positive impact on patients’ lifestyle was also reported. A total of 44 patients were regular smokers when they were first referred. Half of these went on to give up. Seven patients drank more than the recommended weekly intake of alcohol when they were first assessed. This fell to just one after treatment at the clinic.

Pharmacist involvement also led to more patients receiving optimum drug therapy. For example, almost two-thirds of patients (143) were not receiving all the drugs (ie, angiotensin converting enzyme [ACE]-inhibitors, beta-blockers and spironolactone) they needed on referral. This was reduced to 50 following treatment, with most of those not receiving these drugs being either intolerant of them or having contra-indications. Similarly, the number of patients receiving “medium” or “high” doses (appropriate in the circumstances) rose from 43 to 134 for beta-blockers, from 107 to 153 for ACE-inhibitors and from 129 to 201 for angiotensin receptor blockers.

Valerie Ross, specialist heart failure pharmacist at Barts and The London NHS Trust, said: “The specialist pharmacists and nurses who staff these clinics work with doctors to ensure patients receive the right medication at the right doses. They can also offer advice to patients to encourage them to give up smoking, cut down on the amount of alcohol they drink and improve their overall health. The results from this study show the clinics are benefiting patients.”