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Natriuretic Peptide Screening for Primary Prevention or Early Detection of Heart Failure: A Pharmacist-Driven
Meghan Martin1, Daisy Peterson2, Casie Yentz2
1Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia.
Insights
Natriuretic peptide screening identifies patients with hypertension and type 2 diabetes mellitus at high risk for heart failure (HF). Clinical pharmacists provide comprehensive management to prevent HF progression.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Emerging data suggests natriuretic peptide biomarker screening and early intervention can prevent left ventricular dysfunction and new-onset heart failure (HF).
- The 2017 ACC/AHA/HFSA guideline recommends natriuretic peptide biomarker screening and a team-based approach for HF prevention.
Purpose of the Study:
- To establish a protocol for identifying patients at risk for HF using natriuretic peptide screening.
- To evaluate the role of clinical pharmacists in managing patients identified at high risk for HF.
Main Methods:
- Clinical pharmacists collaborated with specialists to create a protocol for HF risk identification.
- Patients with hypertension and/or type 2 diabetes mellitus (T2DM) and elevated N-terminal pro-B-type natriuretic peptide levels (>125 pg/mL) were identified for follow-up.
- Follow-up included medication management (renin-angiotensin system inhibitors), echocardiogram discussion, and comprehensive disease management.
Main Results:
- Natriuretic peptide screening successfully identified patients with hypertension and/or T2DM at higher risk for HF.
- Clinical pharmacists provided comprehensive medication management and disease state control for identified high-risk patients.
Conclusions:
- Natriuretic peptide screening is effective in identifying patients at risk for HF.
- Clinical pharmacists play a crucial role in managing high-risk HF patients through comprehensive medication management and disease state optimization.
Background:
Emerging data indicates that natriuretic peptide biomarker-based screening and early intervention could prevent left ventricular dysfunction or new-onset heart failure (HF). The 2017 update of the American College of Cardiology/ American Heart Association/Heart Failure Society of America guideline for managing HF provides a IIa recommendation for natriuretic peptide biomarker screening followed by a team-based approach for preventing HF.
Observations:
Clinical pharmacists worked collaboratively with a cardiology specialist and primary care practitioners to establish a protocol to identify patients at risk for HF. Patients with hypertension and/or type 2 diabetes mellitus (T2DM) and without a history of HF with N-terminal pro-B-type natriuretic peptide > 125 pg/mL received follow-up from clinical pharmacists, including initiation and/or adjustment of reninangiotensin system inhibitors, discussion of echocardiogram, and comprehensive disease state management of hypertension, T2DM, atherosclerotic cardiovascular disease risk reduction, oral nonsteroidal anti-inflammatory drug reduction, and tobacco cessation.
Conclusions:
By using natriuretic peptide screening, clinical pharmacists were able to identify patients with hypertension and/or T2DM who were at higher risk for HF and provide comprehensive medication management.
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