Effects of pharmacist interventions on heart failure outcomes: A systematic review and meta-analysis

Abstract

Heart failure (HF) patients tend to have multiple comorbidities resulting in complex therapy regimens and medication adherence issues. Nevertheless, the evidence of pharmacists' contributions to improving clinical outcomes in HF is limited. To assess the impact of pharmacist intervention on all-cause hospitalization, mortality, and quality of life (QoL) in HF) patients. A systematic search of PubMed, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and CINAHL was performed up to April 30, 2020. Randomized controlled trials (RCTs) evaluating pharmacist interventions compared with usual care in adult HF patients were selected. Data were extracted independently by two authors. Random effects meta-analysis models were used to pool treatment effects and confidence intervals (CIs). Twenty-nine trials identified 6965 predominantly HF with reduced ejection fraction (HFrEF) patients. The average age was 72.0 years (interquartile range [IQR] 66.0-76.0) and 48% were men (IQR 40.0%-68.0%). The majority were New York Heart Association (NYHA) Functional class (FC) II-III with median left ventricular ejection fraction (LVEF) of 38.5% (IQR 34.5%-49.5%). Pharmacist interventions were associated with a significant reduction of all-cause mortality (risk ratio [RR] 0.72; 95% CI 0.58-0.89; P = 0.003) and all-cause hospitalizations (RR 0.87; 95% CI 0.77-0.99; P = 0.041). A significant increase in the 36-item Short form Health survey (SF-36) on role physical (Mean deviation [MD], 8.5; 95% CI, 1.00 to 16.01, P = 0.026) and mental health (MD, 7.49; 95% CI, 3.88 to 11.10, P < 0.001) were observed. In addition, a significant improvement in Minnesota Living with Heart Failure Questionnaire score was observed (MD -3.55; 95% CI -6.28 to −0.82; P = 0.01). Pharmacist interventions in patients with HF significantly reduced all-cause mortality and hospitalizations and improved QoL. Integration of a pharmacist into a HF care team or care pathway should be strongly considered as an important element of a multidisciplinary team.