Pharmacists Have a Place in ACS Patient Care

APRIL 26, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
Improved survival after myocardial infarction has swelled the ranks of heart failure patients to 26 million Americans.

Almost half of patients (44%) admitted for heart failure complications are readmitted within 6 months because of disease progression, suboptimal medication management or nonadherence, and comorbid conditions.

Pharmacists have innovated medication management clinics, inpatient anticoagulation services, and transitional care services by introducing patient-centered philosophies. Incorporation of pharmacists into multidisciplinary acute coronary syndrome (ACS) and heart failure care could potentially help reduce all-cause and condition-related hospitalizations and mortality.

In a new study published in the April 2016 issue of the Journal of Clinical Pharmacy and Therapeutics, a team of researchers indicated that pharmacist inclusion in ACS and heart failure patient care has a limited impact on major outcomes, but a definite impact on others.

The researchers assessed 26 studies and qualitatively meta-analyzed 14 of them to determine pharmacists’ impact on ACS and heart failure care.

The studies were too weak to determine any effect of pharmaceutical care on major and patient-centered outcomes. The one important exception was that patients in pharmacist-intensive care groups were significantly more likely to take angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers than those who received usual care.

The rate of all-cause hospitalization was lower in patients with pharmacist interventions, but this finding was inconclusive.

One study found multidisciplinary interventions reduced all-cause admissions and mortality. Another supported that finding, but it didn’t find a mortality benefit.

Differing definitions of pharmaceutical care and evaluation criteria obscure individual findings when systematically analyzed. The researchers attempted to control for this issue by excluding studies with I2 values greater than 60% (which differentiates homogeneity from heterogeneity), or those that used a fixed-effects or random-effects model.

These findings suggest pharmacist interventions in heart failure care can decrease all-cause hospitalization, but they may not affect all-cause mortality or cardiac-related hospitalization.

The bottom line: pharmacists have a place in the care of ACS and heart failure patients.