The Journal of Faculty of Pharmacy of Ankara University is an international medium, an open access, peer-reviewed journal for the publication of original research reports, reviews and short communications in English or Turkish on relevant developments in pharmaceutical sciences., Proceeding of scientific meetings may be published as special issues of supplements to the journal. Additionally, it contains previous and forthcoming national and international scientific meetings with social activities in pharmaceutical areas.
Research Article
Year 2025,
Volume: 49 Issue: 2, 16 - 16
Abstract
Objective: This study was conducted to detect and prevent drug-related problems (DRP) and potentially inappropriate medication (PIM) in patients with heart failure (HF) through a medication review service provided by clinical pharmacists and to increase drug prescription rates according to guideline-directed medical therapy (GDMT).
Material and Method: In this prospective study, which included observation and intervention periods, medication review services were provided to patients with HF between September 2023 and March 2024 by two clinical pharmacists. DRPs were classified according to Hepler-Strand and PIMs were evaluated according to Beers criteria®.
Result and Discussion: A total of 162 DRPs (1.8 per patient) were detected in 90 patients. The most common cause of DRPs was untreated indication (66.05%). In the observation period, no recommendations were offered, whereas in the intervention period, recommendations were offered to cardiologists, and 63.3% of them were implemented. DRPs were prevented and decreased by recommendations from two clinical pharmacists (from 1.76 to 0.64; p < 0.001). The prescription rates of sodium-glucose co-transporter 2 inhibitors and mineralocorticoid receptor antagonists increased (p<0.05). However, there was no difference in the number of PIMs per patient after the intervention (p>0.05). Our results provide compelling evidence that clinical pharmacists' assessment of medication use in patients with HF has made a crucial contribution to treatment management aligning treatment management with current guidelines and reducing DRPs.
Keywords
Clinical pharmacist drug-related problems heart failure potentially inappropriate medications
Ethical Statement
The study with protocol code 09.2023.866 was approved by the Clinical Research Ethics Committee of Marmara University Faculty of Medicine. This study was conducted in accordance with the Declaration of Helsinki and the Clinical Research Ethics Committee. Written informed consent was obtained from all participants included in this study.
Supporting Institution
There are no supporting institutions
Thanks
We would like to thank the physicians and other health professionals in the cardiology service of the hospital where we conducted our study.
References
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- 5. Patil, T., Ali, S., Kaur, A., Akridge, M., Eppes, D., Paarlberg, J., Parashar, A., Jarmukli, N. (2022). Impact of pharmacist-led heart failure clinic on optimization of guideline-directed medical therapy (PHARM-HF). Journal of Cardiovascular Translational Research, 15(6), 1424-1435. [CrossRef]
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- 9. Sandhu, A.T., Kohsaka, S., Turakhia, M.P., Lewis, E.F., Heidenreich, P.A. (2022). Evaluation of quality of care for US veterans with recent-onset heart failure with reduced ejection fraction. JAMA Cardiology, 7(2), 130-139. [CrossRef]
- 10. Stolfo, D., Lund, L.H., Becher, P.M., Orsini, N., Thorvaldsen, T., Benson, L., Camilla, H., Ulf, D., Gianfranco, S., Savarese, G. (2022). Use of evidence‐based therapy in heart failure with reduced ejection fraction across age strata. European Journal of Heart Failure, 24(6), 1047-1062. [CrossRef]
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- 12. Lenzen, M.J., Boersma, E., Scholte op Reimer, W.J., Balk, A.H., Komajda, M., Swedberg, K. (2015). Underutilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: A report from the Euro Heart Survey on Heart Failure. European Heart Journal, 26(24), 2706-2713. [CrossRef]
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- 18. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. [CrossRef]
- 19. Unlu, O., Levitan, E.B., Reshetnyak, E., Kneifati-Hayek, J., Diaz, I., Archambault, A., Chen, L., Hanion, J.T., Maurer, M.S., Safford, M.M., Lachs, M.S., Goyal, P. (2020). Polypharmacy in older adults hospitalized for heart failure. Circulation: Heart Failure, 13(11). [CrossRef]
- 20. Goyal, P., Bryan, J., Kneifati‐Hayek, J., Sterling, M.R., Banerjee, S., Maurer, M.S., Lachs, M.S., Monika, M., Safford, M.M. (2019). Association between functional impairment and medication burden in adults with heart failure. Journal of the American Geriatrics Society, 67(2), 284-291. [CrossRef]
- 21. Stefil, M., Dixon, M., Bahar, J., Saied, S., Mashida, K., Heron, O., Shantsila, E., Walker, L., Akpan, A., Lip, G.Y.H., Sankaranarayanan, R. (2022). Polypharmacy in older people with heart failure: Roles of the geriatrician and pharmacist. Cardiac Failure Review, 8. [CrossRef]
- 22. Jaber, D., Vargas, F., Nguyen, L., Ringel, J., Zarzuela, K., Musse, M., Kwak, M.J., Levitan, E.B., Maurer, M.S., Lachs, M.S., Safford, M.S., Goyal, P. (2022). Prescriptions for potentially inappropriate medications from the beers criteria among older adults hospitalized for heart failure. Journal of Cardiac Failure, 28(6), 906-915. [CrossRef]
- 23. Amankwa, H.M., Marfo, A.F.A., Buabeng, K.O., Nkansah, F.A., Boateng, D.P., Ankrah, D.N.A. (2022). Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana. Health Science Reports, 5(5). [CrossRef]
- 24. Zaal, R.J., den Haak, E.W., Andrinopoulou, E.R., van Gelder, T., Vulto, A.G., van den Bemt, P.M. (2020). Physicians’ acceptance of pharmacists’ interventions in daily hospital practice. International Journal of Clinical Pharmacy, 42, 141-149. [CrossRef]
- 25. Gopineni, D., Manohar Reddy, Y.V., Reddy Mahesh, N., Rajesh, A., Kumar, K. (2019). Heralding the drug related problems by using hepler-strand classification in a tertiary care teaching hospital. Global Journal of Pharmacy & Pharmaceutical Sciences, 7(5), 146-150. [CrossRef]
- 26. Movva, R., Jampani, A., Nathani, J., Pinnamaneni, S.H., Challa, S.R. (2015). A prospective study of the incidence of medication-related problems in general medicine ward of a tertiary care hospital. Journal of Advanced Pharmaceutical Technology & Research, 6(4), 190-194. [CrossRef]
- 27. Dempsey, J.T., Matta, L.S., Carter, D.M., Stevens, C.A., Stevenson, L.W., Desai, A.S., Cheng, J.W. (2017). Assessment of drug therapy-related issues in an outpatient heart failure population and the potential impact of pharmacist-driven intervention. Journal of Pharmacy Practice, 30(3), 318-323. [CrossRef]
- 28. Milfred-LaForest, S.K., Chow, S.L., DiDomenico, R.J., Dracup, K., Ensor, C.R., Gattis-Stough, W., Heywood J.T., Lindenfeld, J., Page II MSPH, R.L., Patterson, H., Vardeny, O., Massie, B.M. (2013). Clinical pharmacy services in heart failure: An opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. Journal of Cardiac Failure, 19(5), 354-369. [CrossRef]
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- 30. McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, C.G.F., Crespo-Leiro, M.G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A.W., Jaarsma, T., Jankowska, E.A., Lainscak, M., Lam, C.S.P., Lyon, A.R., McMurray, J.J.V., Mebazaa, A., Mindham, R., Muneretto, C., Piepoli, M.F., Price, S., Rosano, G.M.C., Ruschitzka, F., Skibelund, A. K. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42(36), 3599-3726. [CrossRef]
- 31. Campbell, G., Doherty, C., D'Silva, A., Carr-White, G., Webb, J., Ismail, T.F. (2024). Implementation and evaluation of specialist heart failure pharmacist prescribing clinics. International Journal of Clinical Pharmacy, 47, 8-14. [CrossRef]
- 32. Khalil, V., Danninger, M., Wang, Wkhalil., H. (2017). An audit of adherence to heart failure guidelines in an Australian hospital: A pharmacist perspective. Journal of Evaluation in Clinical Practise, 23(6), 1195-1202. [CrossRef]
Year 2025,
Volume: 49 Issue: 2, 16 - 16
Abstract
Amaç: Bu çalışma, klinik eczacılar tarafından sağlanan ilaç inceleme hizmeti aracılığıyla kalp yetersizliği (KY) hastalarında ilaçla ilişkili sorunları (İLİS) ve olası uygunsuz ilaçları tespit etmek ve önlemek ve kılavuza dayalı tıbbi tedaviye göre ilaç reçete oranlarını artırmak amacıyla yürütülmüştür.
Gereç ve Yöntem: Gözlem ve müdahale dönemlerini içeren bu prospektif çalışmada, Eylül 2023 ile Mart 2024 tarihleri arasında KY hastalarına iki klinik eczacı tarafından ilaç inceleme hizmeti sunulmuştur. İLİS'ler Hepler-Strand'a göre sınıflandırılmış ve olası uygunsuz ilaçlar Beers kriterlerine® göre değerlendirilmiştir.
Sonuç ve Tartışma: 90 hastada toplam 162 İLİS (hasta başına 1.8) tespit edildi. İLİS'lerin en sık nedeni tedavi edilmemiş endikasyondu (%66.05). Gözlem döneminde herhangi bir öneri sunulmamışken, müdahale döneminde kardiyologlara öneriler sunulmuş ve bunların %63.3'ü uygulanmıştır. Ancak müdahaleden sonra tespit edilen hasta başına düşen olası uygunsuz ilaç sayısında bir fark yoktu. İki klinik eczacının önerileriyle İLİS'ler önlendi ve azaltıldı (1.76'dan 0.64'e; p < 0.001). Sonuçlarımız, klinik eczacılar tarafından KY hastalarında ilaç kullanımının değerlendirilmesinin, tedavi yönetimini güncel kılavuzlarla uyumlu hale getirerek ve İLİS'leri azaltarak tedavi yönetimine önemli bir katkı sağladığına dair ikna edici kanıtlar sunmaktadır.
References
- 1. Parajuli, D.R., Shakib, S., Eng-Frost, J., McKinnon, R.A., Caughey, G.E., Whitehead, D. (2021). Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients. BMC Cardiovascular Disorder, 21, 104. [CrossRef]
- 2. Suzuki, M., Matsue, Y., Izumi, S., Kimura, A., Hashimoto, T., Otomo, K., Saito, H., Suzuki, M., Kato, Y., Funakoshi, R. (2018). Pharmacist-led intervention in the multidisciplinary team approach optimizes heart failure medication. Heart and Vessels, 33, 615-622. [CrossRef]
- 3. Savarese, G., Becher, P.M., Lund, L.H., Seferovic, P., Rosano, G.M., Coats, A.J. (2022). Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research, 118(17), 3272-3287. [CrossRef]
- 4. Değertekin, M., Erol, Ç., Ergene, O., Tokgözoğlu, L., Aksoy, M., Erol, M. K., Eren, M., Kozan, O. (2012). Heart failure prevalence and predictors in Turkey: HAPPY study. Archives of the Turkish Society of Cardiology, 40(4), 298-308.[CrossRef]
- 5. Patil, T., Ali, S., Kaur, A., Akridge, M., Eppes, D., Paarlberg, J., Parashar, A., Jarmukli, N. (2022). Impact of pharmacist-led heart failure clinic on optimization of guideline-directed medical therapy (PHARM-HF). Journal of Cardiovascular Translational Research, 15(6), 1424-1435. [CrossRef]
- 6. Boully, C., Hanon, O. (2015) Insuffisance cardiaque et pathologies associées. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement,13(1), 13-22. [CrossRef]
- 7. Croke, L. (2020). Beers criteria for inappropriate medication use in older patients: An update from the AGS. American Family Physician, 101(1), 56-57.
- 8. Heidenreich, P.A., Bozkurt, B., Aguilar, D., Allen, L.A., Byun, J.J., Colvin, M.M., Yancy, C.W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of American College of Cardiology, 145(18). [CrossRef]
- 9. Sandhu, A.T., Kohsaka, S., Turakhia, M.P., Lewis, E.F., Heidenreich, P.A. (2022). Evaluation of quality of care for US veterans with recent-onset heart failure with reduced ejection fraction. JAMA Cardiology, 7(2), 130-139. [CrossRef]
- 10. Stolfo, D., Lund, L.H., Becher, P.M., Orsini, N., Thorvaldsen, T., Benson, L., Camilla, H., Ulf, D., Gianfranco, S., Savarese, G. (2022). Use of evidence‐based therapy in heart failure with reduced ejection fraction across age strata. European Journal of Heart Failure, 24(6), 1047-1062. [CrossRef]
- 11. Barker, A., Barlis, P., Berlowitz, D., Page, K., Jackson, B., Lim, W.K. (2012). Pharmacist directed home medication reviews in patients with chronic heart failure: A randomized clinical trial. International Journal of Cardiology,159(2), 139-143. [CrossRef]
- 12. Lenzen, M.J., Boersma, E., Scholte op Reimer, W.J., Balk, A.H., Komajda, M., Swedberg, K. (2015). Underutilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: A report from the Euro Heart Survey on Heart Failure. European Heart Journal, 26(24), 2706-2713. [CrossRef]
- 13. Maggioni, A.P., Anker, S.D., Dahlström, U., Filippatos, G., Ponikowski, P., Zannad, F. (2013). Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC heart failure long‐term registry. European Journal Heart Failure, 15(10), 1173-1184. [CrossRef]
- 14. Driscoll, A., Currey, J., Tonkin, A., Krum, H. (2015). Nurse‐led titration of angiotensin-converting enzyme inhibitors, beta‐adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction. Cochrane Database Systematic Reviews, 12. [CrossRef]
- 15. Hsu, W.T., Shen, L.J., Lee, C.M. (2016). Drug-related problems vary with medication category and treatment duration in Taiwanese heart failure outpatients receiving case management. Journal of Formosan Medical Association,115(5), 335-342. [CrossRef]
- 16. Gpower (Version 3.1.9.7)* (Computer Software). (2020). Retrieved from https://www.psychologie.hhu. de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower/. Accessed date: 12.06.2023.
- 17. McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, C.G.F., Crespo-Leiro, M.G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A.W., Jaarsma, T., Jankowska, E.A., Lainscak, M., Lam, C.S.P., Lyon, A.R., McMurray, J.J.V., Mebazaa, A., Mindham, R., Muneretto, C., Piepoli, M.F., Price, S., Rosano, G.M.C., Ruschitzka, F., Skibelund, A.K. (2023). 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 44(37), 3627-3639. [CrossRef]
- 18. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. [CrossRef]
- 19. Unlu, O., Levitan, E.B., Reshetnyak, E., Kneifati-Hayek, J., Diaz, I., Archambault, A., Chen, L., Hanion, J.T., Maurer, M.S., Safford, M.M., Lachs, M.S., Goyal, P. (2020). Polypharmacy in older adults hospitalized for heart failure. Circulation: Heart Failure, 13(11). [CrossRef]
- 20. Goyal, P., Bryan, J., Kneifati‐Hayek, J., Sterling, M.R., Banerjee, S., Maurer, M.S., Lachs, M.S., Monika, M., Safford, M.M. (2019). Association between functional impairment and medication burden in adults with heart failure. Journal of the American Geriatrics Society, 67(2), 284-291. [CrossRef]
- 21. Stefil, M., Dixon, M., Bahar, J., Saied, S., Mashida, K., Heron, O., Shantsila, E., Walker, L., Akpan, A., Lip, G.Y.H., Sankaranarayanan, R. (2022). Polypharmacy in older people with heart failure: Roles of the geriatrician and pharmacist. Cardiac Failure Review, 8. [CrossRef]
- 22. Jaber, D., Vargas, F., Nguyen, L., Ringel, J., Zarzuela, K., Musse, M., Kwak, M.J., Levitan, E.B., Maurer, M.S., Lachs, M.S., Safford, M.S., Goyal, P. (2022). Prescriptions for potentially inappropriate medications from the beers criteria among older adults hospitalized for heart failure. Journal of Cardiac Failure, 28(6), 906-915. [CrossRef]
- 23. Amankwa, H.M., Marfo, A.F.A., Buabeng, K.O., Nkansah, F.A., Boateng, D.P., Ankrah, D.N.A. (2022). Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana. Health Science Reports, 5(5). [CrossRef]
- 24. Zaal, R.J., den Haak, E.W., Andrinopoulou, E.R., van Gelder, T., Vulto, A.G., van den Bemt, P.M. (2020). Physicians’ acceptance of pharmacists’ interventions in daily hospital practice. International Journal of Clinical Pharmacy, 42, 141-149. [CrossRef]
- 25. Gopineni, D., Manohar Reddy, Y.V., Reddy Mahesh, N., Rajesh, A., Kumar, K. (2019). Heralding the drug related problems by using hepler-strand classification in a tertiary care teaching hospital. Global Journal of Pharmacy & Pharmaceutical Sciences, 7(5), 146-150. [CrossRef]
- 26. Movva, R., Jampani, A., Nathani, J., Pinnamaneni, S.H., Challa, S.R. (2015). A prospective study of the incidence of medication-related problems in general medicine ward of a tertiary care hospital. Journal of Advanced Pharmaceutical Technology & Research, 6(4), 190-194. [CrossRef]
- 27. Dempsey, J.T., Matta, L.S., Carter, D.M., Stevens, C.A., Stevenson, L.W., Desai, A.S., Cheng, J.W. (2017). Assessment of drug therapy-related issues in an outpatient heart failure population and the potential impact of pharmacist-driven intervention. Journal of Pharmacy Practice, 30(3), 318-323. [CrossRef]
- 28. Milfred-LaForest, S.K., Chow, S.L., DiDomenico, R.J., Dracup, K., Ensor, C.R., Gattis-Stough, W., Heywood J.T., Lindenfeld, J., Page II MSPH, R.L., Patterson, H., Vardeny, O., Massie, B.M. (2013). Clinical pharmacy services in heart failure: An opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. Journal of Cardiac Failure, 19(5), 354-369. [CrossRef]
- 29. Anker, S.D., Butler, J., Filippatos, G., Ferreira, J. P., Bocchi, E., Böhm, M., Brunner-La Rocca, H.P., Choi, D.J., Chopra, V., Chuquiure-Valenzuela, E., Giannetti, N., Gomez-Mesa, J.E., Janssens, S., Januzzi, J.L., Gonzalez-Juanatey, J.R., Merkely, B., Nicholls, S.J., Perrone, S.V., Piña, I.L., Ponikowski, P., Senni, M.., Sim, D., Spinar, J., Squire, I., Taddei, S., Tsutsui, H., Verma, S.,Vinereanu, D., Zhang, J., Carson, P., Lam, C.S.P., Marx, N., Cordula Zeller, Dipl.Math., Naveed Sattar, M.D., Waheed Jamal, M.D., Sven Schnaidt, M.Sc., Janet M. Schnee, Brueckmann, M., Pocock, S.J., Zannad, F., Packer, M. (2021). Empagliflozin in heart failure with a preserved ejection fraction. New England Journal of Medicine, 385(16), 1451-1461. [CrossRef]
- 30. McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, C.G.F., Crespo-Leiro, M.G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A.W., Jaarsma, T., Jankowska, E.A., Lainscak, M., Lam, C.S.P., Lyon, A.R., McMurray, J.J.V., Mebazaa, A., Mindham, R., Muneretto, C., Piepoli, M.F., Price, S., Rosano, G.M.C., Ruschitzka, F., Skibelund, A. K. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42(36), 3599-3726. [CrossRef]
- 31. Campbell, G., Doherty, C., D'Silva, A., Carr-White, G., Webb, J., Ismail, T.F. (2024). Implementation and evaluation of specialist heart failure pharmacist prescribing clinics. International Journal of Clinical Pharmacy, 47, 8-14. [CrossRef]
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There are 32 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Pharmacy and Pharmacy Practice |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | May 9, 2025 |
| Publication Date | |
| Submission Date | November 15, 2024 |
| Acceptance Date | March 3, 2025 |
| Published in Issue | Year 2025 Volume: 49 Issue: 2 |