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A Systematic Review of Randomized Trials

Sheri L. Koshman, BScPharm, PharmD, ACPR; Theresa L. Charrois, BSc(Pharm), MSc; Scot H. Simpson, BSP, PharmD, MSc; Finlay A. McAlister, MD, MSc, FRCPC; Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP

Arch Intern Med. 2008;168(7):687-694.

Background  While the role of multidisciplinary teams in the treatment of patients with heart failure (HF) is well established, there is less evidence to characterize the role of individual team members. To clarify the role of pharmacists in the care of patients with HF, we performed a systematic review evaluating the effect of pharmacist care on patient outcomes in HF.

Methods  We searched PubMed, MEDLINE, EMBASE, International Pharmaceutical Abstracts, Web of Science, Scopus, Dissertation Abstracts, CINAHL, Pascal, and Cochrane Central Register of Controlled Trials for controlled studies from database inception to August 2007. We included randomized controlled trials that evaluated the impact of pharmacist care activities on patients with HF (in both inpatient and outpatient settings). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of all-cause hospitalization, HF hospitalization, and mortality.

Results  A total of 12 randomized controlled trials (2060 patients) were identified. Extent of pharmacist involvement varied among studies, and each study intervention was categorized as pharmacist-directed care or pharmacist collaborative care using a priori definitions and feedback from primary study authors. Pharmacist care was associated with significant reductions in the rate of all-cause hospitalizations (11 studies [2026 patients]) (OR, 0.71; 95% CI, 0.54-0.94) and HF hospitalizations (11 studies [1977 patients]) (OR, 0.69; 95% CI, 0.51-0.94),and a nonsignificant reduction in mortality (12 studies [2060 patients])(OR, 0.84; 95% CI, 0.61-1.15). Pharmacist collaborative care led to greater reductions in the rate of HF hospitalizations (OR, 0.42; 95%CI, 0.24-0.74) than pharmacist-directed care (OR, 0.89; 95% CI, 0.68-1.17).

Conclusions  Pharmacist care in the treatment of patients with HF greatly reduces the risk of all-cause and HF hospitalizations. Since hospitalizations associated with HF are a major public health problem, the incorporation of pharmacists into HF care teams should be strongly considered.

Author Affiliations: Division of Cardiology,Faculty of Medicine and Dentistry (Drs Koshman and Tsuyuki and Ms Charrois), Faculty of Pharmacy and Pharmaceutical Sciences (Ms Charrois and Drs Simpson and Tsuyuki), and Division of General Internal Medicine,Faculty of Medicine and Dentistry (Dr McAlister), University of Alberta,Edmonton, Canada.