West Lucianne M, Williams J Bradley, Faulkenberg Kathleen D
Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave, Hb-105, Cleveland, OH, 44195, USA.
Curr Treat Options Cardiovasc Med. 2019 Sep 10;21(10):59. doi: 10.1007/s11936-019-0750-3.
A multidisciplinary approach is vital to reduce mortality and hospitalizations in patients with heart failure. As members of the multidisciplinary team, pharmacists are uniquely positioned to care for patients across the spectrum of heart failure. This comprehensive review explores the different facets in which pharmacists can be utilized to impact the care for patients with heart failure, including those with cardiac transplant and left ventricular assist devices (LVADs), in the outpatient setting.
Pharmacists can see heart failure patients in a variety of settings to reduce drug therapy-related issues, increase use of guideline-directed medical therapy (GDMT), and reduce hospitalizations. Although there is limited data available, pharmacists have also been described in aiding the therapeutic drug monitoring of warfarin for patients with LVADs and immunosuppression agents in the transplant population. Through collaborative practice agreements, pharmacists can provide progressive services such as titration of GDMT and lab monitoring, in addition to medication reconciliation, education, and review for potential drug-related problems. Pharmacists can increase access to patient care by providing services through distance-visits, shared medical appointments, and home visits.
多学科方法对于降低心力衰竭患者的死亡率和住院率至关重要。作为多学科团队的成员,药剂师在照顾心力衰竭各阶段患者方面具有独特的地位。本综述全面探讨了药剂师可用于影响心力衰竭患者护理的不同方面,包括门诊环境中接受心脏移植和左心室辅助装置(LVAD)治疗的患者。
药剂师可以在多种环境中诊治心力衰竭患者,以减少与药物治疗相关的问题,增加指南导向药物治疗(GDMT)的使用,并减少住院次数。尽管现有数据有限,但也有报道称药剂师可协助对接受LVAD治疗的患者进行华法林治疗药物监测,并对移植患者的免疫抑制剂进行监测。通过协作实践协议,药剂师除了进行用药核对、教育以及审查潜在的药物相关问题外,还可以提供诸如调整GDMT和实验室监测等进阶服务。药剂师可以通过远程问诊、共享医疗预约和家访等方式提供服务,从而增加患者获得医疗护理的机会。