TY - JOUR
T1 - The evidence for pharmacist care in outpatients with heart failure
T2 - a systematic review and meta-analysis
AU - Schumacher, Pia M.
AU - Becker, Nicolas
AU - Tsuyuki, Ross T.
AU - Griese-Mammen, Nina
AU - Koshman, Sheri L.
AU - McDonald, Michael A.
AU - Bouvy, Marcel
AU - Rutten, Frans H.
AU - Laufs, Ulrich
AU - Böhm, Michael
AU - Schulz, Martin
N1 - Funding Information:
None received. We thank the following authors of primary studies who answered our requests for further information: John McMurray, Pamela Heaton, William Hogg, Carmel Hughes, Adel Sadik, James McElnay, Frank Molnar, and Susan Poole. We also thank Katrin Krueger for her thorough preliminary work in the literature search and an early draft of the manuscript. Finally, thanks to Margit Schmidt, Department of Medicine, ABDA, Berlin, for her support in searching and retrieving the literature.
Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2021/10
Y1 - 2021/10
N2 - AIMS: Patients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF.METHODS AND RESULTS: We conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta-analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta-analyses. Differences in all-cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84-1.12], Q-statistic, P = 0.49, I
2 = 0%), all-cause hospitalizations (OR = 0.86 [0.73-1.03], Q-statistic, P = 0.01, I
2 = 45.5%), and HF hospitalizations (OR = 0.89 [0.77-1.02], Q-statistic, P = 0.11, I
2 = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49-1.01], P < 0.01), with no indication of heterogeneity (Q-statistic, P = 0.64; I
2 = 0%).
CONCLUSIONS: Results indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline-directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients.
AB - AIMS: Patients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF.METHODS AND RESULTS: We conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta-analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta-analyses. Differences in all-cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84-1.12], Q-statistic, P = 0.49, I
2 = 0%), all-cause hospitalizations (OR = 0.86 [0.73-1.03], Q-statistic, P = 0.01, I
2 = 45.5%), and HF hospitalizations (OR = 0.89 [0.77-1.02], Q-statistic, P = 0.11, I
2 = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49-1.01], P < 0.01), with no indication of heterogeneity (Q-statistic, P = 0.64; I
2 = 0%).
CONCLUSIONS: Results indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline-directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients.
KW - Heart failure
KW - Meta-analysis
KW - Outpatients
KW - Pharmacist care
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85109378814&partnerID=8YFLogxK
U2 - 10.1002/ehf2.13508
DO - 10.1002/ehf2.13508
M3 - Review article
C2 - 34240570
AN - SCOPUS:85109378814
SN - 2055-5822
VL - 8
SP - 3566
EP - 3576
JO - ESC heart failure
JF - ESC heart failure
IS - 5
ER -