Table 1.

Pertinent studies evaluating pharmacists’ intervention in HF patient management

References	Study characteristics	Design	Intervention	Intervention setting	Outcomes
Eggink et al10	N = 85 Intervention prior to discharge	Randomized controlled study	• Medication education • Medication reconciliation, communication with community pharmacists, and patients’ primary care doctors • By pharmacists	Inpatient	Reduce risk of one or more medication error (RR, 0.57; 95% CI, 0.37–0.88)
Kripalani et al11	N = 851 Intervention prior to discharge with follow-up	Randomized controlled study	• Medication education • Medication reconciliation, communication with community pharmacists, and patients’ primary care doctors • By pharmacists	Inpatient	Incidence ratio of medication error: intervention versus no intervention (incidence rate ratio, 0.92; 95% CI, 0.77–1.10)
Jain et al15	N = 234 Outpatient clinic service	Before and after intervention comparison	• Dose titration of HF medications based on a protocol • By pharmacist or nurse	Clinic	• Improvement in guideline-driven medication prescribing rate • Reduction of patients categorized in the NYHA functional classes III and IV (from 93 [40%] to 53 [23%])
Roblek et al16	N = 213 In hospital patients with decompensated HF	Open-label comparative trial	• Pharmacists screening for drug interactions	Inpatient	Significantly reduced number of clinically relevant drug–drug interactions (8 vs 18; p = 0.003) • No reduction in rehospitalization
Stewart et al18,19	N = 97 Intervention prior to discharge with follow-up	Randomized controlled study	• Single home visit within 1 week of discharge from hospital by a nurse or a pharmacist • Optimize medication management, identify early clinical determination, intensify necessary medical follow-up	Inpatient	Few unplanned readmission (36 vs 63, p = 0.03) in the intervention group
Rainville23	N = 377 Interventions prior to hospital discharge with follow-up	Randomized controlled study	• By a pharmacist and a nurse • Identification of hospital readmission risk factors, recommendation of medication changes to physicians if necessary	Inpatient	Less HF readmission (24% vs 59%, p < 0.05)
Patel et al25	N = 18 Intervention prior to discharge and follow-up	Controlled study	• By a pharmacist • Drug therapy evaluation, counseling over the telephone, recommended drug therapy changes to the physicians	Inpatient	No difference in number of readmission
Varma et al21	N = 83 Outpatient clinic service	Randomized controlled study	• By a pharmacist • Education on HF, prescribed drugs and symptom management, contacted physician if needed	Clinic	Improved exercise capacity, better compliance with drug therapy, fewer hospital readmissions (14 vs 27, p = 0.006)
Gattis et al22	N = 181 Outpatient clinic service	Randomized controlled study	• By a pharmacist • Extensive education and counseling on medications, discussed and optimized patients’ drug regimen with physician, necessary recommendations regarding HF therapy, discussed changes made in drug therapy with patients, telephone follow-up	Clinic	All-cause mortality and HF rehospitalization were significantly lower in the intervention group compared with the control group (4 vs 16; p = 0.005)
Whellan et al24	N = 117 Outpatient clinic service	Nonrandomized	• By a pharmacist • Reviewed medications with patients, provided a medication appraisal for physicians	Clinic	Increase beta-blocker use (52% vs 76% for beta-blocker, p < 0.01; 6% vs 13% of target dose, p < 0.01), decreased hospitalization rate (1.5 vs 0 hospitalizations per patient-year, p < 0.01)
Goodyer et al20	N = 82 Home-based intervention	Randomized controlled study	• By a pharmacist • Intensive counseling using a standard written protocol	Patient home	Intervention group patients showed significantly higher medication adherence (93% vs 51%, p < 0.001)
Lowrie et al26	N = 1,090 Outpatient clinic service	Randomized controlled study	• By a pharmacist • Medication initiation and dose titration	Clinic	Did not improve patient clinical outcome
Gwadry-	N = 134	Randomized	• By pharmacists and nurse educators	Clinic	Did not improve mortality or hospital readmission
Sridhar et al27	Outpatient clinic service	controlled study	• Education on medication adherence, dietary and lifestyle modification
López-Cabezas et al28	N = 134 Intervention prior to discharge and follow-up	Randomized controlled study	• By pharmacists • Education on disease, diet, and drug therapy	Inpatient	Reduced risk of rehospitalization at 12 months (HR, 0.56; 95% CI, 0.32–0.97)
Jackevicius et al29	N = 277 Posthospital discharge follow-up in a multidisciplinary HF clinic	Retrospective cohort study	• By a multidisciplinary team including pharmacists on all aspects of HF education	Clinic	Reduction of 90-day time-to-first HF readmission or all-cause mortality (adjusted HR, 0.28; 95% CI, 0.06–0.31)
Hale et al30	N = 122 Posthospital discharge follow-up in a pharmacist-managed VA HF bridge clinic	Retrospective cohort study	• By pharmacists	Clinic	• 30-day death and all-cause readmission significantly lower (adjusted HR, 0.44; 95% CI, 0.22–0.88, p = 0.02)

Abbreviations: HF, heart failure; NYHA, New York Heart Association; RR, relative risk; VA, Veterans Affairs Healthcare System.