Geriatric individuals with heart failure (HF) who visit a pharmacist once each week are more prone to adhere to their medication regimen and exhibit a more active lifestyle, according to results from the PHARM-CHF randomized, controlled trial presented late last month at Heart Failure 2019, a scientific congress of the European Society of Cardiology.
The PHARM-CHF trial investigated whether regularly seeing a pharmacist improves adherence to HF medications. A total of 237 ambulatory chronic HF patients aged 60 years and older were randomly allocated to usual care or a pharmacy intervention and monitored for a median of 2 years. The average age was 74 years, 62% were male, and the median number of different drugs was nine. Nonadherence encompasses failing to fill a prescription, taking a lower dose or fewer pills than prescribed, drug holidays (skipping medications during weekends or holidays, or when feeling better), or completely stopping one or more drugs.
The intervention began with a medication review where the pharmacist created a medication plan, looked for drug interactions and double medications, and reached out to the physician about any risks. Patients then visited the pharmacy every 8 to 10 days to discuss adherence and symptoms and to assess blood pressure and pulse-rate status. Drugs were provided in a pillbox with compartments for morning, noon, evening, and night on each day.
The primary study efficacy endpoint was the proportion of days that three heart failure medications were collected in the year after randomization. Compared with usual care, the intervention resulted in a significant 5.7% increase.
The researchers also calculated the proportion of patients who collected the three drugs at least 80% of the days under study (defined as adherent) compared with baseline. The proportion of adherent patients increased from 44% to 86% in the pharmacy group and from 42% to 68% in the usual care group—a significant 18% difference. Patients in the pharmacy group were three times more likely to become adherent compared with the usual-care, control arm. In addition, they experienced improved quality of life (QoL) after 1 year and significantly better QoL compared with the usual care group after 2 years.
The crucial role of medication adherence is also the focus of this issue, including the CE article (page 40) examining the critical place of adherence in treating diabetes. The feature article (page 19) covering adherence in patients prescribed statin drugs points out a troubling dichotomy: Even though the number of patients indicated to benefit from statin therapy is on the increase, its use remains suboptimal owing to concerns about tolerability and adherence.
In addition, this issue’s cover article (page 15) reports on the increasingly valuable and recognized role of the pharmacist in providing medication-adherence counseling, offering such techniques as motivational interviewing to ramp up adherence results.
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