Pharmacist Management and Quality of Care for Heart Failure With Reduced Left Ventricular Ejection Fraction

Pharmacist medication management may improve the treatment of heart failure.

The authors sought to examine the trends in pharmacist use for heart failure management in the VA (Veterans Affairs) Health Care System and the association with guideline-recommended medication therapy.

The authors identified patients with recent-onset heart failure with reduced ejection fraction (HFrEF) ≤40% (HFrEF) in the VA Health Care System from 2017 to 2021. They determined the association of pharmacist management within 6 months of initial HFrEF diagnosis date and optimal guideline-recommended medication at 12 months following incident HFrEF diagnosis (use of all of the following where no contraindications: renin-angiotensin system inhibitors, beta-blocker, and mineralocorticoid receptor antagonist.

Among the 104,517 patients with recent-onset HFrEF, 10,657 (10.2%) had a pharmacist encounter within 6 months of diagnosis; this increased from 7.0% in 2017 to 14.3% in 2021. Among patients without contraindications to therapy, those with a pharmacist encounter were more likely to be on all recommended therapy when compared to those without a pharmacist encounter (31% vs 15%, all P < 0.0001). Use of individual treatments were also higher in those with a pharmacist encounter (angiotensin receptor-neprilysin inhibitor: 23% vs 12%, beta-blocker: 89% vs 69%, mineralocorticoid receptor antagonist: 43% vs 25%, all P < 0.0001). After adjustment for patient characteristics, a pharmacist encounter was associated with greater odds of optimal therapy (adjusted OR: 2.51; 95% CI: 2.39-2.63).

Pharmacists are increasingly involved in managing heart failure in the VA Health Care System. Pharmacist management was associated with increased guideline-recommended medication use.