Elsevier

Journal of Cardiac Failure

Volume 9, Issue 5, October 2003, Pages 404-411
Journal of Cardiac Failure

Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study

https://doi.org/10.1054/S1071-9164(03)00130-1Get rights and content

Abstract

Background

Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure. Several studies have aimed to reduce rehospitalizations in heart failure patients through a comprehensive, multidisciplinary approach. Medication compliance was rarely measured in these studies or, when it was measured, the method employed was seldom valid. We aimed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure.

Methods

We conducted a randomized controlled trial into the effect of a pharmacist-led intervention on medication compliance in patients with heart failure (predominantly New York Heart Association [NYHA] II and III) treated with loop diuretics, presenting to a cardiology outpatient clinic or admitted to hospitals in The Netherlands. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period. Patients in the control group received usual care. Primary endpoint was medication compliance, assessed with a medication event monitoring system, an electronic pill bottle that registers time of opening. Secondary endpoints were the number of rehospitalizations, death, and quality of life.

Results

A total of 152 patients were randomized: 74 patients to the intervention arm and 78 patients to the usual care arm. Over the 6-month study period, patients in the intervention group had 140/7656 days without use of loop diuretics compared with 337/6196 days in the usual care group (relative risk 0.33 [confidence interval (CI) 95% 0.24–0.38]). Two consecutive days of nondosing occurred on 18/7656 days in the intervention group compared with 46/6196 days in the usual care group (relative risk 0.32 [CI 95% 0.19–0.55]). There were no significant differences in rehospitalizations, mortality, or disease-specific quality of life between groups.

Conclusions

A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure, even in those with relatively high compliance. Future interventions should also focus at less compliant patients.

Section snippets

Selection criteria

Only patients treated with loop diuretics were eligible for inclusion into the study. Patients had been admitted to 1 of the participating hospitals for heart failure (ICD-9, 428) or attended a specialist outpatient heart failure clinic. The diagnosis of heart failure was validated with patient’s hospital records and included cardiac imaging findings. Patients who had severe psychiatric problems or dementia, planned admission to a nursing home, did not take care of their own medication (eg,

Results

A total of 79 pharmacies participated in the study. Of the 152 patients included in the study, 78 were randomly allocated to the usual care group and 74 to the pharmacy-led intervention (Fig. 1). Patients were predominantly male and New York Heart Association (NYHA) class 2 and 3. Comorbidities and comedication in both groups were comparable. There were no differences in type, daily dose, and dosing schedule of loop diuretics (Table 1).

Discussion

This study showed that a pharmacist-led intervention improves diuretic compliance for patients with moderate to severe heart failure. After multivariate analysis, allocation to the intervention group remained the only determinant that was significantly associated with higher compliance. Compliance was found to be unexpectedly high in both the intervention and the usual care groups (mean >90%). Other studies have suggested that noncompliance occurs in approximately 50% of elderly heart failure

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    J. Urquhart is chief scientist of AARDEX Ltd, the manufacturer of MEMS devices used for electronic monitoring in this study. AARDEX was not a sponsor of the study. Part of the study was funded by an unrestricted research grant from an independent non-profit foundation for the efficient use of medicines: Doelmatige Geneesmiddelenvoorziening Midden Nederland (DGMN).

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