Search

Background: The multidisciplinary approach to managing heart failure has been shown to improve outcomes. The role of a clinical pharmacist in treating heart failure has not been evaluated. Methods: One hundred eighty-one patients with heart failure and left ventricular dysfunction (ejection fraction ,45) undergoing evaluation in clinic were randomized to an intervention or a control group. Patients in the intervention group received clinical pharmacist evaluation, which included medication evaluation, therapeutic recommendations to the attending physician, patient education, and follow-up telemonitoring. The control group received usual care. The primary end point was combined all-cause mortality and heart failure clinical events. All clinical events were adjudicated by a blinded end point committee. Results: Baseline characteristics were similar except for slightly higher age in the intervention group. Median follow-up was 6 months. All-cause mortality and heart failure events were significantly lower in the intervention group compared with the control group (4 vs 16; P = .005). In addition, patients in the intervention group received higher angiotensin-converting enzyme inhibitor doses as reflected by the median fraction of target reached (25th and 75th percentiles), 1.0 (0.5 and 1) and 0.5 (0.1875 and 1) in the intervention and control groups, respectively (P,.001). The use of other vasodilators in angiotensin-converting enzyme inhibitor‐intolerant patients was higher in the intervention group (75% vs 26%; P = .02). Conclusions: Outcomes in heart failure can be improved with a clinical pharmacist as a member of the multidisciplinary heart failure team. This observation may be due to higher doses of angiotensin-converting enzyme inhibitors and/or closer follow-up. Arch Intern Med. 1999;159:1939-1945

Background: To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of-blocker use and cost to the health care system. Methods: After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization. Results: We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months.-Blocker use and dose significantly increased (52% vs 76% for -blocker, P.01; 6% vs 13% of target dose, P.01). The hospitalization rate decreased (1.5 vs 0 hospitalizations per patient-year, P.01), while the number of clinic visits increased (4.3 vs 9.8 clinic visits per patient-year, P.01). The Duke University Health System saved a median of $8571 per patient-year. Conclusions: Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF. Arch Intern Med. 2001;161:2223-2228