Key result
While overall guideline adherence did not significantly change, the introduction of multidisciplinary care involving a clinical pharmacist significantly increased the prescription of evidence-based beta-blockers at discharge from 24.1% to 38.6% (p<0.001).
Why the study?
Discharge prescriptions for heart failure patients may not adhere to clinical practice guidelines, prompting evaluation of multidisciplinary care including a clinical pharmacist.
Does the inclusion of a clinical pharmacist in a multidisciplinary care team improve guideline-directed medical therapy prescribing for heart failure patients at discharge from a critical care unit?
Cohort (n=284)
No
Does the inclusion of a clinical pharmacist in a multidisciplinary care team improve guideline-directed medical therapy prescribing for heart failure patients at discharge from a critical care unit?
Integrating clinical pharmacists into critical care multidisciplinary teams can help optimize specific components of guideline-directed medical therapy, such as beta-blocker prescription, for heart failure patients at discharge.
Pharmacist-inclusive multidisciplinary HF care was associated with higher beta-blocker prescribing at discharge; leaves open impact on overall guideline adherence or outcomes.
Discharge prescriptions for heart failure (HF) patients may not adhere to the clinical practice guidelines. This study aimed to assess the impact of the clinical pharmacist as a member of a multidisciplinary team on the quality of prescribing to HF patients at discharge from a Critical Care Unit (CCU) in Egypt. This was a retrospective cohort study of HF patients discharged from the CCU between January 2013 and December 2017. Guideline Adherence Index (GAI-3) was used to assess guideline-directed prescribing at discharge. Multidisciplinary care was introduced to the CCU on 1 January 2016. The study included 284 HF patients, mean (±SD) age 66.7 ± 11.5 years, 53.2% male. Heart failure with reduced ejection fraction affected 100 patients (35.2%). At discharge, loop diuretics were prescribed to 85.2% of patients; mineralocorticoid receptor antagonists to 54.9%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to 51.4%; and β-blockers to 29.9%. Population Guideline Adherence Index (GAI-3) was 45.5%. High-GAI was prescribed to 136 patients (47.9%). Patients with High-GAI were younger; less affected by chronic kidney disease and had fewer comorbidities than those without High-GAI. Prescription of β-blocker increased (24.1% vs. 38.6%, p < 0.001) and digoxin utilization decreased (34.7% vs. 23.7%, p < 0.049) after the introduction of the multidisciplinary care. The inclusion of a clinical pharmacist in the multidisciplinary care team may have a role in optimizing the prescribing of HF guideline-directed therapies at discharge from this setting.
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Hadidi et al. (2020) conducted a cohort in Heart Failure (n=284). Multidisciplinary care including a clinical pharmacist vs. Routine care by critical care physicians was evaluated on Heart failure guideline-led prescribing at discharge using the Guideline Adherence Index (GAI-3). While overall guideline adherence did not significantly change, the introduction of multidisciplinary care involving a clinical pharmacist significantly increased the prescription of evidence-based beta-blockers at discharge from 24.1% to 38.6% (p<0.001).
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