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Treatment-Related Issues for HF Patients

July 07, 2017

Many patients with heart failure have a number of comorbidities for which they are required to take multiple medications to treat. Given the heavy medication usage, this patient population has a high prevalence of drug therapy-related issues (DRIs) for which a pharmacist can play a vital role in addressing.

These are among the key findings of a recent pilot study that looked at the prevalence of comorbidities and DRIs in 60 patients with heart failure seen in an outpatient center designed to provide heart failure patients with comprehensive multidisciplinary interventions.

Among the interventions provided at the outpatient center, called the Ambulatory Cardiac Triage, Intervention, and Education (ACTIVE) infusion unit located at Brigham and Women’s Hospital, are those delivered by a dedicated pharmacist that include counseling regarding medications and adherence.

One goal of the pilot study was to further look at and define the potential role of a pharmacist as part of the multidisciplinary team serving the patients in this outpatient unit.

The study found that among the 60 patients included in the study, the most common cardiac-related comorbidities were hypertension (73%), hyperlipidemia (62%), atrial fibrillation (57%), and coronary artery disease (57%), and the most common noncardiac comorbidities were chronic kidney disease (60%), diabetes (50%), obesity (35%), gout (35%), major depressive disorder (25%), and cancer (25%).

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On average, each patient was taking 14 different medications to treat these comorbidities (with a range of 4-27 medications). A key finding of the study was the high prevalence of DRIs. These issues including patients in need of additional or alternative therapy, administered the wrong drug, given suboptimal dosing, given dosing that exceeded the maximum recommended, and having an adverse drug reaction.

Lead author of the study, Jillian T. Dempsey, PharmD, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, underscored that a pharmacist made recommendations to modify a patient’s medication regime in 63 (22%) DRIs.

“Pharmacists, as members of an interdisciplinary team, can play a vital role in effectively identifying and resolving DRI by assessing, optimizing, and streamlining medication regimens, especially those related to commonly identified comorbidities,” she said.

In addition, she stressed the crucial role pharmacists lay in monitoring and managing drug interactions, assessing adverse drug reactions, providing medication education, as well as assisting patients with access to medications.

Mary Beth Nierengarten

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