Pharmacists can do more for heart failure patients


Are hospitalized heart failure patients getting adequate discharge instructions, such as counseling on diet, exercise, medication management, and smoking cessation? Not according to the results of a new study released by the world's largest heart failure registry-ADHERE (Acute Decompensated Heart Failure National Registry).

The ADHERE registry, sponsored by Scios Inc., a Johnson & Johnson company, collects observational data from across the United States in order to track and study the clinical characteristics and medical management of patients hospitalized with acute heart failure.

The ADHERE study claimed that only 32% of inpatient heart failure patients get the recommended discharge counseling. The study evaluated 105,388 patients discharged with heart failure from 274 hospitals nationwide between January 2001 and January 2004. Among the findings: There was room for improvement in hospital compliance with quality-of-care indicators published by the Joint Commission on Accreditation of Healthcare Organizations as part of its quality improvement initiative for heart failure.

The study also pointed to glaring differences between patients hospitalized for heart failure and those selected for clinical trials in acute heart failure. "Preliminary data coming out of this study are clearly showing us that the general population is fairly different from the people we see in clinical trials," said J. Herbert Patterson, Pharm.D., associate professor of pharmacy at the University of North Carolina, Chapel Hill, School of Pharmacy.

Patterson noted that the registry is providing healthcare professionals with valuable information, including how to characterize the heart failure patient population. "That will help us to design future clinical trials to study this population differently than we have in the past."

With only 32% of patients receiving discharge instructions, Patterson said, pharmacists are poised to play a greater role in counseling. "There's a lot of room for us as pharmacists to have more involvement," he explained. "This is a very sick population. They're going to be on a lot of medications." Pharmacists should make sure that heart failure patients are on the correct medications at the correct doses and that they know how to take their meds, he added.

Another key point from the ADHERE findings is that only 66% of patients studied were on an ACE inhibitor. "That number should be higher," said Patterson.

Healthcare experts believe that the best way to address heart failure is to adopt an interdisciplinary approach that includes pharmacists, physicians, and nurses.

According to the American Heart Association, heart failure affects almost five million Americans, with 550,000 new cases emerging each year, and is the most frequent cause of hospitalization in patients over 65.

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