The Role of Pharmacists in the Discharged Patients with Cardiovascular Diseases: A Literature Review

Abstract

Background and Objective: The incidence of heart failure is increasing in developed
countries. In the aged population, heart failure is a common cause of hospitalization
and hospital readmis- sion, which in conjunction with post-discharge care, impose a
significant cost burden. Inappro- priate medication management and drug-related
problems have been identified as major contrib- utors to hospital readmissions. In
order to enhance the care and clinical outcomes, and reduce treatment costs, heart
failure disease management programmes (DMPs) have been developed. It is
recommended that these pro- grammes adopt a multi-disciplinary approach, and
pharmacists, with their understanding and knowledge of medication management,
can play a vital role in the post-discharge care of heart failure patients.
The aim of this literature review was to assess the role of pharmacists in the
provision of post- charge services for heart failure patients.
Method: An extensive literature search was undertaken to identify published studies
and review articles evaluating the benefits of an enhanced medication management
service for patients with heart failure post-discharge.
Results: Seven studies were identified evaluating ‘outpatient’ or ‘post-discharge’
pharmacy services for patients with heart failure. In three studies, services were
delivered prior to discharge with either subsequent telephone or home visit
follow-up. Three studies involved the role of a pharmacist in a specialist heart failureoutpatient clinic. One study focused on a home-based intervention. In six of these
studies, positive outcomes, such as decreases in unplanned hospital read- missions,
death rates and greater compliance and medication knowledge were demonstrated.
One study did not show any difference in the number of hospitalizations between
intervention and control groups. The quality of evidence of the randomized
controlled trials was assessed using the Jadad scoring method. None of the studies
achieved a score of more than 2, out of a maximum of 5, indicating the potential for
bias.
Discussion: The DMPs carried out by pharmacists have contributed to positive patient
outcomes, which has highlighted the value of extending the traditional roles of
pharmacists from the provi- sion of professional guidance to the delivery of continuity
of care through a more holistic and direct approach.
Conclusion: This review has demonstrated the effectiveness of pharmacists’
interventions to reduce the morbidity and mortality associated with heart failure.
However, there is an on-going need for the development and evaluation of pharmacy
services for these patients.