Findings from the PHARM-HF study, presented at the American Heart Association (AHA) 2024 Scientific Sessions, demonstrate that providing pharmacists within the Veterans Health Administration (VHA) System with feedback on their patients’ heart failure medication rates, along with educational tools, enhances their management and adjustment of these medications. This intervention addresses the growing burden of heart failure, expected to affect over 8 million US adults by 2035, and leverages pharmacists' roles in medication reconciliation, patient education, and collaborative medication management.
Pharmacist Integration in Heart Failure Care
Within the VHA System, primary care pharmacists are integrated into primary care panels, collaborating with physicians and nurses to optimize medication management. According to lead study author Alexander Tarlochan Singh Sandhu, MD, MS, a cardiologist specializing in heart failure at Stanford University, these pharmacists are empowered to identify patients who would benefit from guideline-recommended treatments and initiate therapy.
Prior to the study, pharmacists averaged 2 patient visits per month for heart failure care and 0.4 visits for medication adjustments.
Study Design and Results
During the study, 120 primary care pharmacists responsible for over 7000 heart failure patients were randomized into three groups: a control group receiving educational materials, an audit and feedback group receiving educational materials and monthly audit and feedback emails, and a third group receiving educational materials, audit and feedback emails, and targeted patient-specific information. The evaluation period spanned from January to May 2024.
Preliminary findings indicated that both intervention groups saw increases in the frequency of heart failure management. The audit and feedback group showed a significant increase, with 1.2 more visits per month and more heart failure medication adjustments. However, providing access to patient-specific information did not yield additional improvements.
Impact on Medication Prescribing
Notably, the study authors observed that monthly audit and feedback emails led to a small but significant increase in the frequency of prescribing mineralocorticoid receptor antagonists, a class of medications historically under-prescribed in heart failure therapy.
Conclusion
According to Dr. Sandhu, pharmacists participating in the audit and feedback group were more likely to identify patients who would benefit from medication adjustment, schedule new appointments, and adjust heart failure medication therapy, potentially leading to improved heart failure management and better patient outcomes.
