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Results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study

Wendy A. Gattis, PharmD, BCPS; Vic Hasselblad, PhD; David J. Whellan, MD; Christopher M. O'Connor, MD

Arch Intern Med. 1999;159:1939-1945.

Background  The multidisciplinary approach to managing heart failure has been shown to improve outcomes. The role of a clinical pharmacist in treating heart failure has not been evaluated.

Methods  One hundred eighty-one patients with heart failure and left ventricular dysfunction (ejection fraction <45) undergoing evaluation in clinic were randomized to an intervention or a control group. Patients in the intervention group received clinical pharmacist evaluation, which included medication evaluation, therapeutic recommendations to the attending physician, patient education, and follow-up telemonitoring. The control group received usual care. The primary end point was combined all-cause mortality and heart failure clinical events. All clinical events were adjudicated by a blinded end point committee.

Results  Baseline characteristics were similar except for slightly higher age in the intervention group. Median follow-up was 6 months. All-cause mortality and heart failure events were significantly lower in the intervention group compared with the control group (4 vs 16; P=.005). In addition, patients in the intervention group received higher angiotensin-converting enzyme inhibitor doses as reflected by the median fraction of target reached (25th and 75th percentiles), 1.0 (0.5 and 1) and 0.5 (0.1875 and 1) in the intervention and control groups, respectively (P<.001). The use of other vasodilators in angiotensin-converting enzyme inhibitor–intolerant patients was higher in the intervention group (75% vs 26%; P=.02).

Conclusions  Outcomes in heart failure can be improved with a clinical pharmacist as a member of the multidisciplinary heart failure team. This observation may be due to higher doses of angiotensin-converting enzyme inhibitors and/or closer follow-up.

From the Division of Cardiology, Department of Medicine, Duke University Medical Center, and the Duke Clinical Research Institute, Durham, NC.

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