Heart Failure Guideline-Directed Medical Therapy: Could Pharmacists Be the Fifth Pillar?

Drs Ileana Piña and Alexander Sandhu discuss the PHARM-HF trial, which tested three strategies to help pharmacists get patients with heart failure on the right drugs at the right doses.
https://www.medscape.com/viewarticle/heart-failure-guideline-directed-medical-therapy-could-2024a1000lde?src=soc_yt

-- TRANSCRIPT --
Ileana L. Piña, MD, MPH: Hello. I’m Ileana Piña, professor of medicine at Thomas Jefferson University, and I am here in beautiful Chicago at the American Heart Association (AHA) meetings. I have with me here a special guest, Dr Alex Sandhu, who is from the Palo Alto Veterans Affairs (VA) Healthcare System. I have a very soft spot in my heart for the veterans.

Tell me a little bit about what you do. You’re a heart failure person like I am.

Alexander T. Sandhu, MD, MS: Yes. I’m a heart failure cardiologist and health services researcher both the Palo Alto VA and at Stanford School of Medicine.

Piña: And you work with my good friend, Paul Heinrich.

Sandhu: He was the senior principal investigator on the project.’

Piña: Tell me the name of your project that was presented at the AHA meeting.

Why Pharmacists?
Sandhu: It’s called PHARM-HF Audit and Feedback. It was a randomized quality improvement study around trying to improve the use of pharmacist care.

Piña: Why do you want pharmacists in a clinic?

Sandhu: As you know, we have over 6 million Americans with heart failure, and that number continues to grow. We’re really fortunate to live in a time where we have incredibly effective medical therapies for reducing the morbidity and mortality of heart failure.

But unfortunately, our patients aren’t getting those therapies for many reasons. Even when they get them, they’re not titrated up to the target doses that we know work. I think we need multipronged, multiple strategies to solve those gaps universally across our healthcare systems.

Piña: Was that your thinking behind this study?

Sandhu: It’s our thinking behind many of our research projects. One thing that Paul, myself, and the VA are really passionate about is the opportunity of expanding the care team for chronic disease management and for heart failure.

We have a lot of data on pharmacists managing hypertension and diabetes. We now have randomized data on the fact that when pharmacists manage heart failure, patients are more likely to be on beta-blockers or renin-angiotensin system (RAS) inhibitors, and have them uptitrated. This project was to see if we implement it on a broader scale.

Piña: This isreally a translational study.

Sandhu: Exactly When we look at VA data, we see that veterans who are cared for by a pharmacist, in terms of their heart failure, have higher rates of guideline-directed medical therapy (GDMT), but we also see that only 10% of veterans with heart failure get heart failure care from a pharmacist. The real premise, is how can we get more pharmacists actively managing heart failure problems?

Piña: Is it an access issue at the VA that they don’t get sent to a pharmacist, or that the pharmacists aren’t embedded in the care? What do you think that difference is?

Sandhu: Actually, a really lucky feature of the VA is that the pharmacists are closely embedded in primary care practices, working side by side with the primary care clinician, and they have a lot of experience with successfully managing diabetes and high blood pressure.

Why that hasn’t translated to heart failure yet is what we’re trying to understand. I think a lot of it has to do with there being less pharmacist training around heart failure management in the primary care setting. And there’s also less focus on heart failure compared with hypertension

Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/heart-failure-guideline-directed-medical-therapy-could-2024a1000lde?src=soc_yt