Collaborative pharmacist prescribing in community heart failure clinics: a pre-post intervention comparison

Guideline-directed medical therapy (GDMT) improves outcomes in heart failure, yet many patients remain undertreated or are not titrated to optimal doses. International evidence shows pharmacist-led heart failure clinics improve GDMT prescribing and reduce hospitalisations, but data in Australian settings are limited.

To evaluate whether incorporating a collaborative pharmacist medication prescribing model within a heart failure service improved optimisation of guideline-directed medical therapy (GDMT) in patients with heart failure and ejection fraction < 50% compared with pre-implementation usual care, and to evaluate impacts on service efficiency, hospitalisation, mortality, medication beliefs, and health-related quality of life.

An interrupted time series analysis compared 12-month pre- and post-implementation periods following establishment of a collaborative pharmacist medication prescribing clinic across two community heart failure services. Primary outcomes were the proportion of patients optimised on GDMT at 90 days and at clinic discharge. Secondary outcomes included time between visits, monthly attendance, unscheduled hospitalisations, medication adherence and health related quality of life (HRQoL) assessed with the EuroQoL five-dimension five-level health status instrument visual analogue scale (EQ-VAS) and the Kansas City Cardiomyopathy Questionnaire (KCCQ-12).

A total of 302 patients with ejection fraction < 50% were included, with 98 and 204 patients in the pre- and post-implementation cohort respectively. Overall, 285 patients (94.4%) had a left ventricular ejection fraction ≤ 40%, with similar proportions between cohorts (94.6% vs. 93.9%; p = 1.000). Optimisation of GDMT increased from 19.3% (n = 19) to 40.2% (n = 82) at 90 days (adjusted OR = 2.6, p = 0.001), and from 43.9% (n = 43) to 88.2% (n = 180) at discharge (adjusted OR = 13.2, p < 0.001). Median time between visits decreased from 49 to 28 days (p < 0.001), while mean monthly attendance increased from 9 to 16 (p < 0.001). HRQoL scores increased within the post-implementation group, measured by the KCCQ-12 (74.0 → 84.8, p < 0.001) and EQ-VAS (73.0 → 79.5, p = 0.004). Medication adherence remained high according to self-reported Medication Adherence Report Scale (MARS) scores. No change in hospitalisations or mortality was observed.

Introducing a collaborative pharmacist medication prescribing clinic to usual care was associated with higher rates of GDMT optimisation and increased clinic throughput. These findings support the feasibility of collaborative prescribing models to facilitate GDMT optimisation within Australian health services.