Pharmacist-led transition of care for heart failure patients

Abstract

Background: Heart failure is associated with a high hospital readmission rate, making it appropriate to test the effectiveness of pharmacist services as part of quality-of-care improvement strategies. This study aimed to implement a pharmacist-led transition-of-care service for heart failure patients and to determine its impact on hospital readmission rate. Methods: The research was conducted over 7 months at Mater Dei Hospital in Malta. Patients with heart failure who were discharged from hospital without pharmacist intervention acted as the control group (N=52). The intervention group (N=27) consisted of heart failure patients who followed a pharmacist-led transition-of-care discharge pathway. Recruitment process involved prospective convenience sampling using predefined eligibility criteria. The primary outcome was the 30-day all-cause unplanned readmission rate. Secondary outcomes included the all-cause unplanned readmission rate during the observation period from days 31–60 post-discharge, the number and type of pharmacist interventions, and number of occasions when discharge was delayed for any pathway intervention to be completed. Results: Fifty-two patients in the control group and 27 patients in the intervention group completed the study. The control and intervention groups differed significantly with respect to reduced ejection fraction, treatment adherence, and use of beta-blockers and aldosterone antagonists (p<0.05). There was a 12.3% absolute reduction in the primary outcome, namely the 30-day unplanned readmission rate, when comparing the intervention group with the control group. This reduction was not sustained at the total 60-day unplanned readmission rate, where no difference between groups was observed. Conclusion: The developed transition-of-care pathway contributed to a reduced readmission rate during the immediate post-discharge period; however, this effect was not sustained at 60 days post-discharge. Further consolidated pharmacist interventions, potentially relying on an enhanced role for community pharmacists, are necessary to impact long-term readmission rates.