Daya Ram Parajuli1, Constance Kourbelis2, Julie Franzon2, Peter Newman2, Ross A Mckinnon3, Sepehr Shakib4, Dean Whitehead2, Robyn A Clark2. 1. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia. Electronic address: para0067@flinders.edu.au. 2. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia. 3. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. 4. Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Abstract
BACKGROUND: There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes. METHODS AND RESULTS: English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2 = 39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2 = 52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care. CONCLUSIONS: The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes.
BACKGROUND: There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes. METHODS AND RESULTS: English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2 = 39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2 = 52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care. CONCLUSIONS: The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes.
Authors: Daya Ram Parajuli; Sepehr Shakib; Joanne Eng-Frost; Ross A McKinnon; Gillian E Caughey; Dean Whitehead Journal: BMC Cardiovasc Disord Date: 2021-02-18 Impact factor: 2.298
Authors: Martin Schulz; Nina Griese-Mammen; Pia M Schumacher; Stefan D Anker; Friedrich Koehler; Christian Ruckes; Volker Rettig-Ewen; Rolf Wachter; Dietmar Trenk; Michael Böhm; Ulrich Laufs Journal: ESC Heart Fail Date: 2020-07-23