"Patients would need to see the pharmacist every week lifelong for the benefits to continue The key point is that pharmacy visits need to be used as an opportunity to provide structured care," said co-principal investigator Martin Schulz, Freie Universitaet, Germany.
"Adhering to a complex medication regimen is a huge challenge for elderly patients with heart failure," pointed Schulz.
"It is estimated that 30-50 per cent of patients in Europe are non-adherent to heart failure medications, which results in increased frequency and severity of symptoms such as breathlessness, worsening heart failure and consequent hospitalisations, and higher mortality," added Schulz.
Non-adherence includes not collecting a prescription, taking a lower dose or fewer pills than prescribed, drug holidays (during weekends or holidays, or when feeling better), or completely stopping one or more drugs.
A total of 237 ambulatory chronic heart failure patients aged 60 years and older were randomly allocated to usual care or a pharmacy intervention and followed-up for a median of two years. The average age was 74 years, 62 per cent were male, and the median number of different drugs was nine.
The intervention started with a medication review. Patients brought their drugs to a pharmacist who made a medication plan, checked for drug interactions and double medications, and contacted the physician about any risks.
Patients then visited the pharmacy every 8-10 days to discuss adherence and symptoms, and have blood pressure and pulse rate measurements. Drugs were provided in a pillbox with compartments for morning, noon, evening, and night on each day. The pharmacist updated the medication plan if needed and contacted the doctor with new drug-related problems or significant changes in vital signs.
The primary efficacy endpoint was the proportion of days three heart failure medications were collected (using pharmacy claims data) in the year after randomisation.
The researchers also calculated the proportion of patients who collected the three drugs at least 80 per cent of the days under study (defined as adherent) compared to baseline.
The proportion of adherent patients increased from 44 per cent to 86 per cent in the pharmacy group and from 42 per cent to 68 per cent in the usual care group - a significant 18 per cent-points difference between groups.
Patients in the pharmacy group were three times more likely to become adherent compared to the usual care group. Six patients would need to receive the intervention to achieve at least 80 per cent adherence in one patient.
Improvement in quality of life was more pronounced in the pharmacy group after one year and significantly better compared to the usual care group after two years. It meant patients in the pharmacy group were less limited in their daily activities and less worried about their disease.