HOOPS: Pharmacist consultation did not reduce HF mortality, hospitalization

AHA Scientific Sessions 2011

ORLANDO, Fla. — A low-intensity, pharmacist-led, collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications, but did not improve clinical outcomes in a population of well-treated patients with heart failure, Richard Lowrie, MSc, MPC, said here.

Researchers for the Heart Failure and Optimal Outcomes from Pharmacy Study (HOOPS) randomly assigned 87 centers and 1,090 patients in Scotland to receive additional attention from a pharmacist who was collaborating with physicians. Pharmacists met with the patients to review medications and write prescriptions for recommended medications. At another 87 centers, 1,074 patients received routine family physician care without additional pharmacist input.

After almost 5 years, both groups had the same rate of death and HF hospitalizations, approximately 35% (HR=0.97; 95% CI, 0.83-1.14).

However, consultation with a pharmacist did increase the number of patients who received recommended HF medications at recommended doses. At the start of the study, 86% of patients were treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. In those not receiving ACE inhibitors or ARBs or who received less than the recommended dose, treatment was started or the dose was increased in 33.1% of patients in the pharmacist consultation group and in 18.5% in the usual-care group (OR=2.26; 95% CI, 1.64-3.10). At baseline, 62% of patients were treated with a beta-blocker; the proportions of starting or having an increase in dose were 17.9% in the pharmacist consultation group and 11.1% in the usual-care group (OR=1.76l 95% CI, 1.31-2.35).

“While our results show that the nonspecialist pharmacist intervention is not that effective in reducing hospitalization or death rates, we did demonstrate the impact pharmacists have on getting patients on recommended HF drugs,” Lowrie, lead Long Term Conditions/Research pharmacist at Greater Glasgow and Clyde Health Service, Scotland, U.K. “This could be an important intervention in health systems with a low number of patients receiving recommended HF drugs.”

A potential mechanism behind the high rate of prescribing of ACE and ARBs reported in this study may be related to pay-for-performance contracts introduced for U.K. family physicians in 2004, which was close to the start of this study, Lowrie said.

The researchers encouraged long-term studies of different collaborative interventions involving different subsets of patients, such as those with severe HF.

For more information:

• Lowrie R. LBCT.02. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.

Disclosure: Dr. Lowrie reports no relevant financial disclosures.

To date, with respect to HF management strategies, 30 minutes with a pharmacist; 3 to 36 hours of novel diuretics or vasodilators like nesiritide or rolofylline; and 3 days of loop diuretic dosing schemes that we heard about in the DOSE study resulted in no change in hospitalization rate. Perhaps it is unrealistic to expect these brief interventions will result in long-term success in chronic diseases such as HF. Moreover, perhaps hospitalization rate is not a reasonable outcome, and we may need to explore other important endpoints, such as patient-reported outcomes.

Mariell Jessup, MD
Professor of medicine
University of Pennsylvania

Disclosure: Dr. Jessup reports no relevant financial disclosures.

Rhonda M. Cooper-DeHoff

While this study did not show a difference in the primary outcome comparing the pharmacy intervention and the usual-care groups, there is an important point to learn: Maximizing medical therapy is a very important point of the overall care of patients with HF, and pharmacists did a good a job of this as primary care physicians. In the current era of health care, in which physicians have so little time to see each patient, especially in the primary care settings, this study provides nice data that support the importance of pharmacists as members of the health care team.

Rhonda M. Cooper-DeHoff, PharmD, MS
Cardiology Today Editorial Board member

Disclosure: Dr. Cooper-DeHoff reports no relevant financial disclosures.

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