Reduction in heart failure events by the addition of a clinical pharmacistto the heart failure management team - Results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study

Background: The multidisciplinary approach to managing heart failure has be en shown to improve outcomes. The role of a clinical pharmacist in treating heart failure has not been evaluated. Methods: One hundred eighty-one patients with heart failure and left ventri cular dysfunction (ejection fraction <45) undergoing evaluation in clinic w ere randomized to an intervention or a control group. Patients in the inter vention group received clinical pharmacist evaluation, which included medic ation evaluation, therapeutic recommendations to the attending physician, p atient education, and follow-up telemonitoring. The control group received usual care. The primary end point was combined all-cause mortality and hear t failure clinical events. All clinical events were adjudicated by a blinde d end point committee. Results: Baseline characteristics were similar except for slightly higher a ge in the intervention group. Median follow-up was 6 months. All-cause mort ality and heart failure events were significantly lower in the intervention group compared with the control group (4 vs 16; P=.005). In addition, pati ents in the intervention group received higher angiotensin-converting enzym e inhibitor doses as reflected by the median fraction of target reached (25 th and 75th percentiles), 1.0 (0.5 and 1) and 0.5 (0.1875 and 1) in the int ervention and control groups, respectively (P<.001). The use of other vasod ilators in angiotensin-converting enzyme inhibitor-intolerant patients was higher in the intervention group (75% vs 26%; P =.02). Conclusions: Outcomes in heart failure can be improved with a clinical phar macist as a member of the multidisciplinary heart failure team. This observ ation may be due to higher doses of angiotensin-converting enzyme inhibitor s and/or closer follow-up.