Effects of pharmacist care on hospitalizations in heart failure across outpatient and inpatient settings: A systematic review and meta-analysis.

Abstract

Aims: Heart failure (HF) is major cause of unplanned (re)hospitalizations, especially in high-risk patients such as those recently discharged or those with worsening HF. Hospital-affiliated or clinic-based pharmacists, though underutilized, may help reduce this burden. This systematic review and meta-analysis assessed their impact on all-cause and HF hospitalizations.

Methods: A systematic literature search using PUBMED and EMBASE and conducted according to PRISMA guidelines identified randomized controlled trials published up to November 2024. Eligible studies evaluated the effects of pharmacy interventions on hospitalizations and mortality among patients with HF. Studies with community pharmacy- or home-based interventions were excluded. Study quality was appraised using the Cochrane risk-of-bias tool. Random-effects models were applied to derive odds ratios (OR), with heterogeneity assessed using the I² statistic and Cochrane's Q test.

Results: Eleven studies were included, involving 3576 patients and a variety of pharmacist interventions. Pharmacists significantly reduced the odds of all-cause hospitalizations compared to usual care (3472 patients, 927 events; OR 0.67, 95% confidence interval [CI]: 0.49-0.92, P = 0.0119). For HF hospitalizations (3442 patients, 504 events), similar results were retrieved (OR 0.64, 95% CI: 0.48-0.87, P = 0.0038). Heterogeneity was moderate for both analyses. Sensitivity analyses supported the robustness of these two analyses. Subgroup analyses indicated greater effectiveness in outpatient settings and when extended interventions were provided.

Conclusions: Across inpatient and outpatient settings, pharmacist interventions in HF significantly reduced all-cause as well as HF hospitalizations. Our findings highlight the importance of integrating pharmacists into multidisciplinary teams to improve HF management for in- and outpatients.