Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study⋆
Section snippets
Selection criteria
Only patients treated with loop diuretics were eligible for inclusion into the study. Patients had been admitted to 1 of the participating hospitals for heart failure (ICD-9, 428) or attended a specialist outpatient heart failure clinic. The diagnosis of heart failure was validated with patient’s hospital records and included cardiac imaging findings. Patients who had severe psychiatric problems or dementia, planned admission to a nursing home, did not take care of their own medication (eg,
Results
A total of 79 pharmacies participated in the study. Of the 152 patients included in the study, 78 were randomly allocated to the usual care group and 74 to the pharmacy-led intervention (Fig. 1). Patients were predominantly male and New York Heart Association (NYHA) class 2 and 3. Comorbidities and comedication in both groups were comparable. There were no differences in type, daily dose, and dosing schedule of loop diuretics (Table 1).
Discussion
This study showed that a pharmacist-led intervention improves diuretic compliance for patients with moderate to severe heart failure. After multivariate analysis, allocation to the intervention group remained the only determinant that was significantly associated with higher compliance. Compliance was found to be unexpectedly high in both the intervention and the usual care groups (mean >90%). Other studies have suggested that noncompliance occurs in approximately 50% of elderly heart failure
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J. Urquhart is chief scientist of AARDEX Ltd, the manufacturer of MEMS devices used for electronic monitoring in this study. AARDEX was not a sponsor of the study. Part of the study was funded by an unrestricted research grant from an independent non-profit foundation for the efficient use of medicines: Doelmatige Geneesmiddelenvoorziening Midden Nederland (DGMN).