Impact of clinical pharmacist-based intervention on outcomes in CHF

We investigated the impact of pharmacologic intervention on outcomes in CHF. We developed a multi-disciplinary disease management program including a clinical pharmacist who assessed appropriateness of drug therapy based on the AHCPR guidelines. All patients had systolic dysfunction defined by echocardiography. For patients on suboptimal therapy, recommendations were made to optimize their drug regimen. Concerted efforts were made to initiate ACE inhibitor therapy and titrate doses to those recommended in the AHCPR guidelines. Of the 110 patients enrolled, treatment was suboptimal in 75% on initial assessment. Principal reasons for suboptimal therapy were failure to use ACE inhibitor (21%) and inadequate dose of ACE inhibitor (54%). In suboptimal cases, clinical pharmacist intervention resulted in 51 cases where therapy was changed to meet the guidelines. In 31 patients, physicians declined pharmacist intervention and patients remained on suboptimal therapy. Optimizing drug regimens lead to improved outcomes for the 90-day period post-discharge: Charges Patient Group (mean, SE) Readmission Appropriate initial therapy $2444 (987) 4 (14%) * Therapy changed to meet guidelines $3297 (986) 4 (8%) * Remained on suboptimal therapy $7024 (2263) 9 (29%) *p<0.05 vs remained on suboptimal therapy Conclusions: Assessment of drug therapy is important in disease management programs and can improve patient outcomes. Intervention by a clinical pharmacist is useful in those cases where treatment regimens did not follow accepted guidelines.