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    Pharmacists' collaboration with primary care did not improve outcomes in heart failure patients, study finds


    Consultation with non-specialist pharmacists did not improve rates of hospitalization or death for patients with left ventricular systolic dysfunction (heart failure), according to the results of a large-scale, long-term prospective randomized trial conducted by the National Health Service and reported at the American Heart Association's Scientific Sessions 2011 in Orlando, Fla.

    The study, conducted by researchers on behalf of the Heart Failure Optimal Outcomes from Pharmacy Study (HOOPS) investigators, was published by the European Heart Journal Advance Access on November 14, 2011.

    In the HOOPS, researchers randomly assigned 87 medical centers with 1,090 patients in Scotland to pharmacists' intervention, working with primary care doctors to optimize medical treatment. Patients from the practices received a 30-minute consultation with a pharmacist to optimize medical treatment for left ventricular systolic dysfunction. If the patient agreed with the pharmacist's recommendations, and the family physician agreed, medications were initiated, discontinued, or modified by the pharmacist during 3 to 4 subsequent weekly or biweekly consultations.

    The primary outcome was a composite of death or hospitalization for worsening heart failure. The median follow-up was 4.7 years. At baseline, 86% of patients in both groups were treated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). In those patients who were not receiving these medications or receiving a lower dose than recommended, treatment was started, or the dose increased, in 33.1% of patients in the intervention group and in 18.5% in the usual care group. At baseline, 62% of each group were receiving beta-blockers and the percentage starting or receiving an increase in dose were 17.9% in the intervention group and 11.1% in the usual care group.

    The primary outcome occurred in 35.8% of those in the intervention group and 35.4% in the usual care group.

    "Even though pharmacists didn't cut the number of deaths or hospitalizations from heart failure, the results appear to strengthen the case for optimizing heart failure drugs," said Richard Lowire, MSc, MPC, the study's lead researcher and lead Long Term Conditions/Research pharmacists at the Greater Glasgow and Clyde Health Service in Scotland, U.K.

    "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 heart failure drugs," Lowrie said. "This could be an important intervention in health systems with a low number of patients receiving recommended heart failure drugs. During our study, a new U.K. contract for family physicians incentivized the prescribing of ACE and ARBs for heart failure, which may have reduced the potential impact of this intervention."

    Long-term studies of different collaborative interventions involving different subsets of patients should be conducted, including those patients with severe heart failure, to determine if hospital admissions can be prevented in these groups, Lowrie said.

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