Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM-CHF randomized controlled trial.

Presented at ESC Heart Failure 2019 in Athens, Greece, by Martin Schulz Berlin, Germany

Introduction and methods

Medication non-adherence is high in patients with chronic heart failure (HF) and 30-50% of patients are estimated to be non-adherent. Non-adherence is associated with increased morbidity, mortality and low quality of life (QoL).

Data from randomized controlled trials (RCT) on interventions are scarce. Therefore, the PHARM-CH trial examined the effect of a pharmacy-based interdisciplinary intervention to improve medication adherence and QoL in elderly chronic HF patients.

The PHARM-CH was a prospective, multicenter, randomized controlled trial that enrolled HF patients ≥60 years, who were on stable HF medication. Patients were randomized to usual care (n=127) or pharmacy care (n=110). Pharmacy care consisted of an initial medication review in the pharmacy, followed by (bi-)weekly pharmacy visits that encompassed counselling, measurement of BP and pulse rate, asking for drug-related problems, and medication dispensed in weekly dosing aids (pillboxes). Median follow-up was 2.0 years. Primary outcome was medication adherence measured as mean proportion of days covered (PDC) at 365 days for 3 HF medication classes: beta-blockers, ACEi/ARB and MRA.

Main results

• After 365 days, adherence to 3 HF medication classes, measured by PDC, was significantly improved in patients who received pharmacy care compared to those receiving usual care (difference of 5.7%, 95%CI: 1.6-9.8, P=0.007).
• Secondary outcome of % patients with PDC ≥80% was significantly higher in the pharmacy care group vs. the usual care group (difference of 18%, OR 2.9, 95%CI: 1.4-5.9, P=0.005), which was mainly driven by a higher percentage of patients taking beta-blockers.
• QoL, measured by MLHFQ global score, was higher in the pharmacy group vs. the usual care group, but this finding was non-significant after 365 days. After 730 days, QoL was significantly improved in the pharmacy group compared to the usual care group.
• There were no increased adverse events with pharmacy care vs. usual care.

Conclusions

Intervention with a pharmacy-based intervention in elderly chronic HF patients resulted in an improvement in adherence of 3 HF medication classes after 365 days and was safe.

Discussion

The discussant Giuseppe Rosano (London, UK) said how this study highlighted the low adherence in the general population. He continued by saying that this is important work and health-practitioners, nurses, pharmacists and other healthcare workers should join forces. This trial demonstrated that this is an effective approach, but Rosano wondered whether it could be more effective with increased interaction with nurses or other clinicians. In addition, he wondered how this could be applied in other countries, as the structures are different per country.

Our reporting is based on the information provided at the ESC Heart Failure 2019 congress

This study was published simultaneously in Eur J Heart Fail