Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic.

BACKGROUND: Drug-related negative outcomes (DNOs) are health problems that patients experience due to drug use or nonuse. Heart failure (HF) patients are at high risk of experiencing DNOs owing to polypharmacy, comorbidities, and age. METHODS AND
RESULTS: Ninety-seven consecutive HF patients were enrolled and followed for 6 months. A pharmacist, integrated within a multidisciplinary HF team, reviewed the medication of each patient to detect, resolve, and/or prevent possible DNOs, risks of developing a DNO (rDNOs) and the drug-related problems (DRPs) that are associated with them. We detected 147 DNOs/rDNOs with a mean of 1.5 ± 1.4 per patient. Among DNOs, 45% were due to a lack of a pharmacologic treatment (need for a drug) and 24% were treatments with an insufficient drug dose (quantitative ineffectiveness). Among rDNOs, 33% were due to use of an unsafe drug (nonquantitative lack of safety) and 30% to quantitative ineffectiveness. Ninety-four percent of DNOs/rDNOs were preventable, and, importantly, 5.5% were classified as clinically serious. During follow-up, pharmacist interventions solved or prevented the health problem in 83% of cases. The most frequently identified DRPs were "insufficiently treated health problem" (31%), "inadequate dose, regimen, or duration of a drug" (22%), "probability of adverse effects" (16%), and "nonadherence" (14%). A significant relationship between the number of DNOs/rDNOs and the number of drugs was found (P < .013).
CONCLUSIONS: Chronic HF outpatients have a high incidence of preventable DNOs. The inclusion of a pharmacist in multidisciplinary HF teams should be considered, because it is clinically beneficial for patients and it increases HF specialists' awareness of DNOs, especially those beyond HF.