Innovation update: Filling a gap in heart-failure care

Results from CFP-funded research on medication optimization for heart-failure patients has captured the attention of the B.C. government.

The pilot randomized control trial (RCT), led by Ricky Turgeon and his research team at the University of British Columbia and funded by CFP’s Innovation Fund, found that even when more than 90% of patients were on guideline-recommended therapies, most were not at target doses.

An Associate Professor at the University and a Clinical Pharmacy Specialist at the PHARM-HF Clinic at St. Paul’s Hospital, Turgeon set out to explore whether pharmacists could play a more active role in managing patients with heart failure, a condition affecting more than 850,000 Canadians.

The pilot RCT, launched in 2023, enrolled 42 patients from the outpatient, telehealth-based PHARM-HF Clinic. Those in the intervention arm received virtual pharmacist consultations every one to two weeks for up to four months, focused on initiating and titrating medications.

At baseline, patients averaged 6.3 out of 8 on a medication optimization scale, reflecting suboptimal dosing. Even in a specialty clinic setting where baseline medication use was already high—92% to 95% across key drug classes—there was still room to optimize therapy.

“The pharmacist can do this sort of work,” says Turgeon. “This is active medication optimization for a complex condition—and [the study] shows pharmacists are up to the task.”

While the pilot was initially designed to inform the development of a larger RCT, growing interest from policymakers has accelerated next steps. Work is now underway with provincial stakeholders, including Cardiac Services BC, to explore broader implementation and build a case for funding.

Additional analysis has strengthened that case. A parallel evaluation found pharmacist-led optimization to be cost-effective: while medication use—and therefore drug costs—increased, these were offset by improvements in quality of life and long-term outcomes.

The focus now is on translating research into practice. “So much research gets done and then doesn’t lead to change,” says Turgeon. “That’s something I don’t want to see with this work.”

Interest is already spreading beyond B.C., with similar models being implemented in the Yukon and explored in Alberta and Nova Scotia.

For Turgeon, the long-term goal is clear: embed pharmacists more fully into multidisciplinary care for patients with heart failure. “It’s about filling gaps—both in access and in medication expertise,” he says.