4CPS-205 Pharmacist’s intervention in the therapeutic management of patients with heart failure – an opportunity for improvement

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Background and Importance Patients with Heart Failure (HF) have high morbidity and mortality, which implies the use of a vast number of drugs. This polymedication is associated with a great potential for drug interactions and lack of adherence to treatment by patients. The balance between the ability to adequately medicate each patient and therapeutic simplification is a challenge for healthcare professionals. Literature suggests that interdisciplinary approach has significant gains in terms of adherence to therapy and quality of life in patients with HF. Aim and Objectives To characterise pharmacist’s interventions in patients with HF followed in a pharmacist consultation at a central hospital. Material and Methods Descriptive, observational, retrospective study, which includes patients referred by the physician for pharmaceutical consultation, between May 2021 and August 2022. Results It were performed 176 pharmaceutical consultations regarding 110 HF patients, 62 males (56%), mean age of 77 ± 11 years. Therapeutic reconciliation and medication review were carried out and an updated pharmacotherapeutic guide was given to these patients as well as education and literacy about the use of medicines. We identified 145 drug interactions of category X or D. Of those, 44 mandatory dose adjustment due to renal function alteration; 27 medications needed administration schedule adjustment; 18 dosage adequacy; 13 discrepancies and 3 required liver function adjustment. In this context, 225 pharmaceutical interventions were performed, 89 were accepted by the physician. Of the remaining, 90 corresponded to suggestions for additional monitoring and 17 were directed to physicians from different specialties who follow these patients for concomitant pathologies. Conclusion and Relevance This data confirms that hospital pharmacists, working collaboratively with the multidisciplinary health team, have a fundamental role in comprehensive medication management as well as in identifying unmet-needs, thus, opportunities for therapy improvement in patients with HF. Pharmaceutical consultation stands as a great opportunity for promoting drug safety and medicines use optimisation. References and/or Acknowledgements 1. Schulz M, Griese-Mammen N, Anker SD, Koehler F, Ihle P, Ruckes C, et al. Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM-CHF randomised controlled trial. Eur J Heart Fail. 2019;21(8):1012–21. Conflict of Interest No conflict of interest

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