Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial.
OBJECTIVE
To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients.


METHODS
Randomised controlled trial.


METHODS
Home based intervention in heart failure patients.


METHODS
293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission.


METHODS
Two home visits by one of 17 community pharmacists within two and eight weeks of discharge. Pharmacists reviewed drugs and gave symptom self management and lifestyle advice. Controls received usual care.


METHODS
The primary outcome was total hospital readmissions at six months. Secondary outcomes included mortality and quality of life (Minnesota living with heart failure questionnaire and EQ-5D).


RESULTS
Primary outcome data were available for 291 participants (99%). 136 (91%) intervention patients received one or two visits. 134 admissions occurred in the intervention group compared with 112 in the control group (rate ratio=1.15, 95% confidence interval 0.89 to 1.48; P=0.28, Poisson model). 30 intervention patients died compared with 24 controls (hazard ratio=1.18, 0.69 to 2.03; P=0.54). Although EQ-5D scores favoured the intervention group, Minnesota living with heart failure questionnaire scores favoured controls; neither difference was statistically significant.


CONCLUSIONS
This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure. Given that heart failure accounts for 5% of hospital admissions, these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits.


BACKGROUND
ISRCTN59427925.
Holland
Richard
R
Clinical Trials Unit, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ. r.holland@uea.ac.uk
Brooksby
Iain
I
Lenaghan
Elizabeth
E
Ashton
Kate
K
Hay
Laura
L
Smith
Richard
R
Shepstone
Lee
L
Lipp
Alistair
A
Daly
Clare
C
Howe
Amanda
A
Hall
Roger
R
Harvey
Ian
I
D003157:Community Pharmacy Services / Q000592:standards*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006699:Home Care Services / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D010349:Patient Compliance; D011788:Quality of Life; D016896:Treatment Outcome