Lead Heart Failure Specialist Pharmacist, Cardiology, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, SA31 2AF, Wales.
Lead Pharmacist Cardiology, NHS Greater Glasgow and Clyde, Glasgow, UK.
Int J Clin Pharm. 2024 Dec;46(6):1247-1255. doi: 10.1007/s11096-024-01790-2. Epub 2024 Aug 27.
Timely diagnosis of heart failure (HF) and rapid optimisation of guideline-directed medication therapy (GDMT) improves patients qualities of life, reducing mortality and morbidity. Previous papers describe the role of pharmacists in medication optimisation, but not in the diagnosis of HF.
To describe the development, implementation, and evaluation of pharmacist-led heart failure clinics with respect to time from referral to diagnosis, time from diagnosis to first review with a specialist, and the proportion receiving optimal GDMT 180 days after diagnosis.
Community outpatient clinics in rural west Wales, United Kingdom.
Two experienced non-medical prescribing pharmacists, one of whom had additional diagnostic qualifications in cardiology, delivered the clinic.
Patients referred with suspected HF were risk-stratified to urgent (within 14 days of referral) or routine (within 42 days) review, based on natriuretic peptide levels. Patients attended the clinic for assessment, including physical examination, electrocardiogram, and echocardiogram. Those with HF with reduced ejection fraction were initiated on drug treatment and referred to the follow-up pharmacist-led GDMT clinic.
A sample of 100 patients was evaluated (50 from pre-existing and 50 from new service). Median time from referral to diagnosis reduced from 61 days (IQR 47-115) to 16 days (IQR 10.5-27.5) for urgent and 19 days (IQR 11.5-33) for routine. Median time to first appointment following diagnosis reduced from 54 days (IQR 36-60.5) to 14 days (IQR 9.75-28.75) (p value < 0.0001), and proportion of patients achieving GDMT at 180 days following diagnosis improved from 24 to 86% (p value < 0.0001).
This pharmacist HF diagnostic clinic and medication optimisation clinic improved time to diagnosis, time to first specialist review, and proportion of patients' achieving GDMT optimisation in a rural healthcare setting.
及时诊断心力衰竭（HF）并快速优化指南指导的药物治疗（GDMT）可改善患者的生活质量，降低死亡率和发病率。先前的论文描述了药剂师在药物优化方面的作用，但未描述在 HF 诊断方面的作用。
描述由药剂师主导的心力衰竭诊所的发展、实施和评估，具体涉及从转介到诊断的时间、从诊断到首次与专家复查的时间，以及在诊断后 180 天内接受最佳 GDMT 的患者比例。
英国威尔士西部农村社区门诊。
两名经验丰富的非医疗处方药剂师，其中一名具有心脏病学额外诊断资格，负责提供该诊所的服务。
根据利钠肽水平，将疑似 HF 的患者分为紧急（转介后 14 天内）或常规（转介后 42 天内）复查。患者接受诊所评估，包括体格检查、心电图和超声心动图。那些射血分数降低的心力衰竭患者开始接受药物治疗，并转介至后续的由药剂师主导的 GDMT 诊所。
对 100 名患者进行了抽样评估（其中 50 名来自现有服务，50 名来自新服务）。从转介到诊断的中位时间从 61 天（IQR 47-115）缩短至 16 天（IQR 10.5-27.5），用于紧急情况；从诊断到首次预约的中位时间从 54 天（IQR 36-60.5）缩短至 14 天（IQR 9.75-28.75）（p 值<0.0001），并且在诊断后 180 天达到 GDMT 的患者比例从 24%提高到 86%（p 值<0.0001）。
在农村医疗环境中，这种由药剂师主导的 HF 诊断诊所和药物优化诊所可改善诊断时间、首次专家复查时间和达到 GDMT 优化的患者比例。
