Beyond Heart Failure: Comprehensive review to improve the care of heart failure (HF) patients by clinical pharmacist at the Portland Veterans Affairs Medical Center (PVAMC)

Background: Heart failure (HF) patients present with multiple competing comorbidities which results in polypharmacy -- leading to non-compliance, drug-drug and drug-disease interactions. A comprehensive drug therapy review is important to screen for response to therapy, drug interactions, or contraindications to medications.

Purpose: The purpose of this project is to improve quality of care for HF patients by providing a comprehensive review of medications and comorbidities.

Methods: Medical records of patients managed by the pharmacist-run HF clinic over the past year were abstracted. Patients with only one clinic visit were excluded from the analysis. A chart audit form was developed to assess quality of care in 5 areas: laboratory monitoring, medication reconciliation, referrals to specialty clinics, recommendations to primary care providers (PCPs), and medication adjustments. All HF clinic notes between the present day and the date of first clinic visit were reviewed to quantify interventions. Data were analyzed using descriptive statistics.

Results: In the past year, 41 patients were seen by the pharmacist. To date, electronic medical records of 35 patients were screened. Of those, 3 patients had only one clinic visit and were excluded from analysis, leaving 32 for further evaluation. A total of 51 recommendations were made to PCPs, of which 29 (57%) were acted on by the PCP resulting in therapy adjustments. Nineteen patients (59%) required updated laboratory values to assess comorbidities. Among these patients, 9 (47%) received therapy modifications to control comorbidities. Referrals were made when indicated. Fifteen patients (47%) received at least one referral and were subsequently scheduled with a specialty clinic. Medication reconciliation identified 38 drug-related problems which were all resolved with therapy adjustments.

Conclusions: The clinical pharmacist trained in HF management provided effective comprehensive care. Our results demonstrate the quality of care pharmacists provide to manage this challenging disease.