title: Assessment of Drug Therapy-Related Issues in an Outpatient Heart Failure Population and the Potential Impact of Pharmacist-Driven Intervention.
abstract: BACKGROUND
  The Ambulatory Cardiac Triage, Intervention, and Education (ACTIVE) infusion unit is an outpatient center that aims to provide heart failure (HF) patients with comprehensive multidisciplinary interventions.
  
  
  OBJECTIVE
  To describe the patient population served in ACTIVE and to document the prevalence of comorbidities and drug therapy-related issues (DRIs) in order to define the most effective role of a pharmacist in the unit.
  
  
  METHODS
  Patients who have been interviewed by a pharmacist in ACTIVE were included. Comprehensive medical and medication profile reviews were performed. Patient comorbidities were documented, and DRIs were classified.
  
  
  RESULTS
  Sixty patients were included. Most prevalent cardiac comorbidities included hypertension (73%) and hyperlipidemia (62%). Top 3 noncardiac comorbidities included chronic kidney disease (60%), diabetes (50%), and obesity (35%). The prevalence of DRI was reported as follows: (1) needs additional/alternative therapy (untreated indication [37] or suboptimal therapeutic choice [46]), (2) wrong drug (major drug-drug interaction [90], contraindication [11], or duplicate therapy [1]), (3) suboptimal dosing (17), (4) dose exceeds recommended maximum (9), and (5) adverse drug reaction (93). In 63 (22%) of the DRIs, a pharmacist made recommendations to modify the regimen.
  
  
  CONCLUSIONS
  The prevalence of DRI is high even among HF patients managed in a subspecialty cardiovascular practice. Pharmacists in this setting play a vital role in more effectively resolving DRI.
authors.affiliation: 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Dempsey
authors.affiliation: 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lina S
authors.initials: LS
authors.lastname: Matta
authors.affiliation: 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Carter
authors.affiliation: 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Stevens
authors.affiliation: 2 Harvard Medical School, Boston, MA, USA.|3 Director, Cardiomyopathy and Heart Failure Program, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.affiliation: 2 Harvard Medical School, Boston, MA, USA.|4 Associate Director, Brigham Cardiovascular Consultants, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.affiliation: 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.|5 MCPHS University-Department of Pharmacy Practice, Boston, MA, USA.
authors.forename: Judy W
authors.initials: JW
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D015331:Cohort Studies; D004347:Drug Interactions / Q000502:physiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010595:Pharmacists; D010865:Pilot Projects; D024382:Professional Role; D014218:Triage / Q000379:methods
keywords: ambulatory care; cardiology; transitions of care