Table 4.

Adherence to heart failure treatment guidelines (ESC Guidelines), GPs=general practitioners

Case number	Treatment guidelines issue	Clinical pharmacist recommendations	GPs acceptance (YES/NO)
1.	Methyldigoxin treatment	Methyldigoxin discontinuation and perindopril initiation	YES
2.	Methyldigoxin treatment	Methyldigoxin discontinuation and enalapril initiation	NO
3.	Methyldigoxin treatment + β-blocker +ACE inhibitor	Methyldigoxin treatment discontinuation	YES
4.	Methyldigoxin treatment +ACE inhibitor	Methyldigoxin treatment discontinuation + β-blocker initiation	YES
5.	Methyldigoxin treatment	β-blocker initiation and ACE inhibitor initiation	NO
6, 7, 8, 9, 10.	Methyldigoxin treatment + β-blocker	Methyldigoxin treatment discontinuation	YES, NO, YES, NO, YES
11.	Methyldigoxin treatment +ACE inhibitor	Methyldigoxin treatment discontinuation + β-blocker initiation	NO
12.	1.25 mg bisoprolol daily	Drug adjustment (2,5 mg daily)	YES
13, 14, 15.	ACE inhibitor treatment	β-blocker adding	NO, NO, NO
16, 17, 18.	ACE inhibitor treatment with verapamil	Verapamil discontinuation and selective β-blocker initiation	NO, NO, NO
19.	Inappropriate dosing of ACE inhibitor and β-blocker	Reduce the ACE inhibitor dose and increase the dose of the β-blocker	NO
20.	Nonselective β-blocker	Switching to bisoprolol	NO, YES
21.	Amlodipine treatment	Amlodipine discontinuation and β-blocker (bisoprolol) initiation	YES

Interventions where CP's recommendations were accepted are presented in a bold form