Pharmacist-Driven Medication Review Service in Patients With Heart Failure: A Prospective Study

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.