title: Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: A randomized, double-blind, controlled trial.
abstract: BACKGROUND
  Incidence of drug-drug interactions (DDIs) increases with complexity of treatment and comorbidities, as in heart failure (HF). This randomized, double-blind study evaluated the intervention of the pharmacist on prevalence of clinically relevant DDIs (NCT01855165).
  
  
  METHODS
  Patients admitted with HF were screened for clinically relevant DDIs, and randomized to control or intervention. All attending physicians received standard advice about pharmacological therapy; those in the intervention group also received alerts about clinically relevant DDIs. Primary endpoint was DDI at discharge and secondary were re-hospitalization or death during follow-up.
  
  
  RESULTS
  Of 213 patients, 51 (mean age, 79 ± 6 years; male, 47%) showed 66 clinically relevant DDIs and were randomized. For intervention (n=26) versus control (n=25), the number of patients with and the number of DDIs were significantly lower at discharge: 8 vs. 18 and 10 vs. 31; p=0.003 and 0.0049, respectively. Over a 6 month follow-up period, 11 control and 9 intervention patients were re-hospitalized or died (p>0.2 for all). No significant differences were seen between control and intervention for patients with eGFR <60 mL/min/1.73 m(2) (78%) for re-hospitalization or death (10 vs. 7; p=0.74).
  
  
  CONCLUSIONS
  Pharmacist intervention significantly reduces the number of patients with clinically relevant DDIs, but not clinical endpoints 6 months from discharge.
authors.affiliation: Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia; Lek d.d., Verovskova 57, Ljubljana, Slovenia.
authors.forename: Tina
authors.initials: T
authors.lastname: Roblek
authors.affiliation: Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia.
authors.forename: Andreja
authors.initials: A
authors.lastname: Deticek
authors.affiliation: Department of Internal Medicine, General Hospital Trbovlje, Rudarska 9, Trbovlje, Slovenia.
authors.forename: Bostjan
authors.initials: B
authors.lastname: Leskovar
authors.affiliation: Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Suskovic
authors.affiliation: Lek d.d., Verovskova 57, Ljubljana, Slovenia.
authors.forename: Matej
authors.initials: M
authors.lastname: Horvat
authors.affiliation: Lek d.d., Verovskova 57, Ljubljana, Slovenia.
authors.forename: Ales
authors.initials: A
authors.lastname: Belic
authors.affiliation: Faculty of Pharmacy, University of Ljubljana, Askerceva cesta 7, Ljubljana, Slovenia.
authors.forename: Ales
authors.initials: A
authors.lastname: Mrhar
authors.affiliation: Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia. Electronic address: mitja.lainscak@guest.arnes.si.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004347:Drug Interactions; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: Clinical relevance; Drug–drug interactions; Heart failure; Intervention; Pharmacist