Pharmacist Intervention in a Heart Failure Clinic
Marie Claire Aquilina, Lilian M. Azzopardi, Anthony Serracino-Inglott
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida Malta
University of Malta
E-mail: maqu0012@um.edu.mt
Introduction
Aim
Heart failure (HF) patients usually require polypharmacy to manage their condi-
To introduce and evaluate the pharmacist’s intervention in HF care within a
tion including medication such as angiotensin-converting enzyme inhibitors,
clinical environment.
and diuretics, as well as medication to treat concurrent disease. Pharmacists
Setting
can benefit HF patient care actively by collaborating with other professionals
Heart Failure Clinic (HFC) at Mater Dei Hospital (MDH) in Malta which is a nurse
1
and supportively by helping patients with their medication .
-driven clinic with cardiologists available as required.
Questionnaire Sections
Method
Questionnaire
compiled

Minnesota Living with Heart Fail2
ure Questionnaire® (MLHFQ) to
assess quality of life (QoL)

Lifestyle

Management of HF

Psychometric testing of
the questionnaire
(validity and reliability)
Microsoft® Excel and SPSS
v.17® (Wilcoxon Signed
Ranks Test) and to assess
for significant changes in
responses to questions
from week 0 to 6
50 patients recruited
by convenience
sampling
Pharmacist Intervention

Adherence
Data Analysis
Ethical approval obtained from
University Research Ethics Committee of University of Malta
2nd interview (Week 6)

Questionnaire readministered to patients

Further queries discussed
with patient
6 weeks
later

1st interview (Week 0)
Preparation of individual patient treatment
chart
Patient advice concerning management of
condition, lifestyle, importance of self-care
and of adherence

Answered queries regarding medication discussed

Encouraged patients to contact HFC if problems arise

Patients completed the
questionnaire

Investigator compiled a
medical history form on
each patient.
Results
ADHERENCE
DEMOGRAPHICAL DATA (n=50):
There was a significant increase from n = 32 (week 0) to n = 47 (week 6) in the
Gender: 42 male, 8 female
Age: 43—83 years (mean age = 65.36)
number of patients who felt the treatment chart was always useful (p<0.001).
There was also a significant increase in patients who improved adherence due
to not forgetting doses and expense of medicines (Table 1).
QUALITY OF LIFE
Patient did not
take medicine
due to
Week
Forgetting
Expenses
A significantly improved QoL at
week 6 was observed since the
lower the MLHFQ score the greater
the QoL (p=0.001) (Figure 1).
LIFESTYLE
Always
0
0
0
6
0
0
Often
0
1
0
6
0
0
Sometimes
0
14
3
6
6
1
Rarely
0
25
7
6
31
2
Never
0
10
40
6
13
47
P-value
0.038
0.038
Figure 1: Mean MLHFQ scores obtained
Table 1: Patients’ responses concerning adherence which showed significance
from week 0 to 6 (n=50)
Conclusion
A significant improvement was noted in daily self-monitoring of weight where
The pharmacist’s participation at the HFC contributed to improving patients’
patients who self-monitored their weight increased from n = 31 (week 0) to n =
QoL. An increase in patients who would refer to a pharmacist signifies in-
43 (week 6) (p=0.008).
creased confidence in the pharmacist’s professional opinion. Patients benefitted from the pharmacist-prepared treatment charts which also included written
MANAGEMENT OF HF
advice. The pharmacist intervention enabled them to understand the impor-
The majority of patients refer to heart specialists, family doctors, and HFC
tance of adherence despite certain issues, which they felt prevented them from
nurses when obtaining information about or experiencing problems with medi-
following their dosage regimen. In conclusion, the pharmacist intervention at
cines. An insignificant increase from n = 8 (week 0) to n = 13 (week 6), was ob-
the HFC was positively evaluated and demonstrated the pharmacist’s potential
served in those referring to pharmacists. The patients who would refer to a
in improving patient care in such a setting.
pharmacist before taking medicines not taken on a regular basis, significantly
References
increased from n = 22 (week 0) to n = 41 (week 6) (p<0.001).
[1] Murray M. Implementing pharmacy practice research programs for the management of heart failure. Pharm World Sci 2010;32:546-8.
[2] University of Minnesota. Minnesota Living with Heart Failure Questionnaire Measures the Effects of Heart Failure and its Treatments on an Individual’s
Quality of Life. [Online]. Last modified: June 2010. [Cited Jan 2011]; [1 screen]. Available from: http://www.license.umn.edu/Products/Minnesotata-LivingLiving--WithWith--HeartHeart--FailureFailure--Questionnaire__Z94019.aspx