Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
J Card Fail. 2011 Mar;17(3):217-23. doi: 10.1016/j.cardfail.2010.10.009. Epub 2010 Dec 24.
Drug-related negative outcomes (DNOs) are health problems that patients experience due to drug use or nonuse. Heart failure (HF) patients are at high risk of experiencing DNOs owing to polypharmacy, comorbidities, and age.
Ninety-seven consecutive HF patients were enrolled and followed for 6 months. A pharmacist, integrated within a multidisciplinary HF team, reviewed the medication of each patient to detect, resolve, and/or prevent possible DNOs, risks of developing a DNO (rDNOs) and the drug-related problems (DRPs) that are associated with them. We detected 147 DNOs/rDNOs with a mean of 1.5 ± 1.4 per patient. Among DNOs, 45% were due to a lack of a pharmacologic treatment (need for a drug) and 24% were treatments with an insufficient drug dose (quantitative ineffectiveness). Among rDNOs, 33% were due to use of an unsafe drug (nonquantitative lack of safety) and 30% to quantitative ineffectiveness. Ninety-four percent of DNOs/rDNOs were preventable, and, importantly, 5.5% were classified as clinically serious. During follow-up, pharmacist interventions solved or prevented the health problem in 83% of cases. The most frequently identified DRPs were "insufficiently treated health problem" (31%), "inadequate dose, regimen, or duration of a drug" (22%), "probability of adverse effects" (16%), and "nonadherence" (14%). A significant relationship between the number of DNOs/rDNOs and the number of drugs was found (P < .013).
Chronic HF outpatients have a high incidence of preventable DNOs. The inclusion of a pharmacist in multidisciplinary HF teams should be considered, because it is clinically beneficial for patients and it increases HF specialists' awareness of DNOs, especially those beyond HF.
药物相关不良后果（DNOs）是患者因用药或未用药而产生的健康问题。心力衰竭（HF）患者因多药治疗、合并症和年龄而面临较高的 DNO 风险。
连续纳入 97 例 HF 患者，随访 6 个月。一名药剂师与多学科 HF 团队合作，审查每位患者的药物治疗情况，以发现、解决和/或预防可能的 DNO、发生 DNO 的风险（rDNOs）以及与它们相关的药物相关问题（DRPs）。我们共发现 147 例 DNO/rDNO，平均每位患者 1.5±1.4 例。在 DNO 中，45%是由于缺乏药物治疗（需要药物），24%是药物剂量不足（定量无效）。在 rDNO 中，33%是由于使用不安全的药物（非定量缺乏安全性），30%是由于定量无效。94%的 DNO/rDNO 是可预防的，重要的是，5.5%被归类为临床严重。在随访期间，药师干预在 83%的情况下解决或预防了健康问题。最常发现的 DRPs 是“未充分治疗的健康问题”（31%）、“药物剂量、方案或持续时间不足”（22%）、“不良反应发生的可能性”（16%）和“不依从”（14%）。DNO/rDNO 的数量与药物的数量之间存在显著的关系（P<.013）。
慢性 HF 门诊患者存在较高比例的可预防 DNOs。应考虑在多学科 HF 团队中纳入药剂师，因为这对患者具有临床益处，并提高 HF 专家对 DNOs 的认识，尤其是 HF 以外的 DNOs。
