Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

Lowrie, R., Mair, F.S. , Greenlaw, N. , Forsyth, P., Jhund, P.S. , McConnachie, A. , Rae, B. and McMurray, J.J.V. (2012) Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. European Heart Journal, 33(3), pp. 314-324. (doi: 10.1093/eurheartj/ehr433)

Abstract

<b>Background</b> Meta-analysis of small trials suggests that pharmacist-led collaborative review and revision of medical treatment may improve outcomes in heart failure.<p></p> <b>Methods and results</b> We studied patients with left ventricular systolic dysfunction in a cluster-randomized controlled, event driven, trial in primary care. We allocated 87 practices (1090 patients) to pharmacist intervention and 87 practices (1074 patients) to usual care. The intervention was delivered by non-specialist pharmacists working with family doctors to optimize medical treatment. The primary outcome was a composite of death or hospital admission for worsening heart failure. This trial is registered, number ISRCTN70118765. The median follow-up was 4.7 years. At baseline, 86% of patients in both groups were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In patients not receiving one or other of these medications, or receiving less than the recommended dose, treatment was started, or the dose increased, in 33.1% of patients in the intervention group and in 18.5% of the usual care group [odds ratio (OR) 2.26, 95% CI 1.64–3.10; P< 0.001]. At baseline, 62% of each group were treated with a β-blocker and the proportions starting or having an increase in the dose were 17.9% in the intervention group and 11.1% in the usual care group (OR 1.76, 95% CI 1.31–2.35; P< 0.001). The primary outcome occurred in 35.8% of patients in the intervention group and 35.4% in the usual care group (hazard ratio 0.97, 95% CI 0.83–1.14; P = 0.72). There was no difference in any secondary outcome.<p></p> <b>Conclusion</b> A low-intensity, pharmacist-led collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications but did not improve clinical outcomes in a population that was relatively well treated at baseline.

• Item Type: Articles
• Additional Information: This is a pre-copy-editing, author-produced PDF of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version [Lowrie, R., Mair, F.S. , Greenlaw, N. , Forsyth, P., Jhund, P.S. , McConnachie, A. , Rae, B., and McMurray, J.V. (2012) Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. European Heart Journal, 33 (3). pp. 314-324. ISSN 0195-668X] is available online at http://dx.doi.org/10.1093/eurheartj/ehr433.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Jhund, Professor Pardeep and Lowrie, Dr Richard and Greenlaw, Miss Nicola and Mair, Professor Frances and McMurray, Professor John
• Authors: Lowrie, R., Mair, F.S., Greenlaw, N., Forsyth, P., Jhund, P.S., McConnachie, A., Rae, B., and McMurray, J.J.V.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: European Heart Journal
• Journal Abbr.: Eur. heart j.
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645
• Published Online: 14 November 2011
• Copyright Holders: Copyright © 2012 Oxford University Press
• First Published: First published in European Heart Journal 33(3):314-324
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher