MARCH 2023 – Even with ample evidence showing that medications improve outcomes in heart failure (HF) patients, few Canadians are receiving optimal pharmacotherapy.
The lack of access to information and newer heart failure medications, along with a shortage of healthcare providers with expertise in HF, are key reasons why, says Dr. Ricky Turgeon, University of British Columbia Assistant Professor and Clinical Pharmacy Specialist.
“Patients and clinicians don’t know about all of the options available to improve outcomes—or they aren’t familiar with how effectively these medications improve outcomes—so they make decisions based on incomplete or inaccurate information,” says Turgeon. “We have a network of heart function clinics in Canada that deliver excellent care, but there simply aren’t enough heart failure physicians…and they tend to be located in larger urban centres.”
As a 2022 Innovation Fund recipient, Turgeon aims to address these problems with a pharmacy-led pilot project for optimizing HF medication use. In doing this pilot, he and his team will determine the feasibility and design of a large-scale randomized control trial using pharmacists to administer interventions remotely that will optimize HF treatment with reduced rejection fraction medications (HFrEF).
The entire pilot will take approximately two years: six months to recruit and randomize 60 patients, 12 months to follow up on patient outcomes, and then six months to plan and launch the larger, ‘definitive’ trial across multiple centres. Patients will be recruited from St. Paul’s Hospital Heart Function Clinic in Vancouver and randomized to usual care or care plus pharmacist-led medication optimization provided by the hospital’s PHARM-HF clinic. This outpatient, telehealth-based clinic led by Turgeon, provides pharmacist co-management of HF medications.
Strong evidence already points to the benefits of involving pharmacists in the care of people with heart failure, including improved patient quality of life and a notable reduction in risk of hospitalization and death. “The missing piece of the puzzle that we’re addressing in this research is how direct medication management delivered remotely can further improve outcomes,” says Turgeon.
The ultimate goal, he says, is to determine if successful pharmacist-led heart failure medication optimization can be adopted into practice and whether it will strengthen the case for further allocation of resources towards clinical pharmacy services. Once this has been established in the context of a heart function clinic, Turgeon sees “opportunities to expand this to pharmacists working in other collaborative settings, including in primary care.