Heart failure: pharmacist support for patients reduced death and hospital attendance

Clinical bottom line (level 1b)

  1. Patients with heart failure attending cardiology clinic who received education and support from a pharmacist compared with usual care were less likely to die, visited an emergency department or be admitted to hospital (NNT = 8 at 6 months) .
Gattis et al: Archives of Internal Medicine 1999; 159 : 1939-1945
Expires November 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: cardiology clinic, university hospital, USA

181 patients (aged mean 67, 68% male) with heart failure and left ventricular dysfunction < 45% undergoing evaluation in clinic

Excluded if
  • not expected to survive 6 months
  • participating in another study
  • lived in a nursing home
  • marked dementia or other psychological disorder

    Control Group: (n = 91, 91 analysed): usual care
    Experimental Group: (n = 90, 90 analysed): interview and education about medication and 3 follow-up telephone calls by a clinical pharmacist

    100% followed for 6 months
    Outcome notes:
    • death or heart failure event : emergency department visit or hospitalisation with heart failure

    The evidence

    Outcome Time to outcome CER EER RRR
    (95% CI)    		 ARR
    (95% CI)    		 NNT
    (95% CI)
    death or heart failure event 24 weeks 16
    (17.6%)    		 4
    (4.44%)    		 75%
    (27% to 91%)    		 13.1%
    (4.23% to 22.0%)    		 8
    (5 to 24)

    Comments

    1. Patients in the intervention group were on average 8 years older than patients in the control group (71 v. 63)

    Citation

    1. Gattis WA, Hasselblad V, Whellan DJ, et al: reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the pharmacist in heart failure assessment recommendation and monitoring (PHARM) study. Archives of Internal Medicine 1999; 159 : 1939-1945
    Search Terms: in ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient heart failure
    Intervention or Exposure pharmacist intervention
    Comparison usual care
    Outcome death, hospitalisation