title: Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial.
abstract: 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.
authors: Clinical Trials Unit, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ. r.holland@uea.ac.uk
authors: Richard
authors: R
authors: Holland
authors: Iain
authors: I
authors: Brooksby
authors: Elizabeth
authors: E
authors: Lenaghan
authors: Kate
authors: K
authors: Ashton
authors: Laura
authors: L
authors: Hay
authors: Richard
authors: R
authors: Smith
authors: Lee
authors: L
authors: Shepstone
authors: Alistair
authors: A
authors: Lipp
authors: Clare
authors: C
authors: Daly
authors: Amanda
authors: A
authors: Howe
authors: Roger
authors: R
authors: Hall
authors: Ian
authors: I
authors: Harvey
mesh_terms: 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