Pharmacist educational interventions program for outpatients with chronic heart failure

Background

Patients with chronic heart failure (CHF) take several medicines and frequently manage their medicines inappropriately. In our hospital, a postdischarge pharmacist educational interventions program (PEIP) has been introduced as a part of a multidisciplinary CHF disease management program.

Purpose

To describe CHF patient profiles, adherence, treatment knowledge and detection of drug-related problems (DRP) through the PEIP. To analyse the relation between DRPs detected and CHF patient characteristics.

Materials and methods

Prospective observational study including all CHF patients attending the PEIP from May 2010 to August 2011. Data: demographics; New York Heart Association (NYHA) class; mean ejection fraction (EF); cardiovascular risk factors (CRF); self-administration of medicine (SA); self-reported adherence to diet (AD) and medicine (AM) and motivation (M) (Modified Morisky Scale); knowledge of CHF medicines: %dose (D), frequency (F) and indication (I); contraindicated drugs (CID) and DRP (DRP1: did not use a needed medicine; DRP2: used a medicine not needed; DRP3: ineffective treatment; DRP4: infradose; DRP5: overdose; DRP6: adverse reaction) and cases of acute decompensation. Statistical test: χ² and Fischer exact test for dichotomous variables and t-test for continuous variables.

Results

Patients: 75. Patient profile: 54 (72%) male; age: 71.8±1.3; patients/NYHA class: I: 2 (2.7%); II: 58 (77.3%); III: 14 (18.7%); IV: 1 (1.3%), EF< 45%: 42(56%); smokers: 20(26.7%); alcohol consumption: 17(22.7%). Adherence and knowledge: SA: 41(54.7%); AD: 56(74.7%); AM: 75(100%); M: 61(81.3%); Mean knowledge of CHF medicine: DFI: 29.7%± 32.0; DF: 47.8%± 41.5; patients who were aware of CID: 12(16%). DRP: 17 patients (22.7%); DRP1: 9 (12%); DRP2: 2(2.7%); DRP3: 6 (8%); DRP4: 3 (4%); DRP5: 2 (2.7%); DRP6: 4(5.3%). Patients with decompensation: 11(14.7%). Comparison between patients with and without DRP: decompensated: 5/17(29.4%) versus 6/58(10.3%)(p=0.05); SA: 12/17(70.6%) versus 29/58(50%)(p=0.134). No other significant differences were observed between the two groups.

Conclusions

The PEIP evaluated the adherence and knowledge of the treatment in CHF patients and allowed us to detect DRPs in about 23% of the patients. The presence of any DRP was only correlated with acute decompensation and self-administration of drugs, suggesting the importance of an appropriate CHF treatment self-management.