The impact of health-system pharmacists on hospitalizations in heart failure: a systematic review and meta-analysis
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Background
Previous evidence has established the role of pharmacists in heart failure (HF) care. However, the specific role of health-system pharmacists within in- and outpatient settings for HF patients has been left unexplored. This systematic review and meta-analysis aimed to evaluate the impact of health-system pharmacy interventions on all-cause and HF hospitalizations.
Methods
A systematic literature search was performed using PUBMED and EMBASE, following PRISMA guidelines. Randomized controlled trials (RCTs) published up to May 2024 that evaluated the effects of health-system pharmacy interventions on hospitalizations in HF patients were included. The quality of the included RCTs was assessed using Cochrane’s risk-of-bias tool. Meta-analyses were performed using random-effects models, with odds ratios (OR) as summary measure. Heterogeneity was assessed using the I 2 statistic and Cochrane’s Q test.
Results
In total, 11 RCTs involving 3576 patients were included in our review. The meta-analysis of 9 RCTs assessing all-cause hospitalizations (3472 patients, 927 events) demonstrated a significant reduction with pharmacist care (OR 0.67, 95% CI: 0.49–0.92, p=0.0119). The second meta-analysis of also 9 RCTs, focusing on HF hospitalizations (3442 patients, 504 events), showed similar results (OR 0.64, 95% CI: 0.48–0.87, p=0.0038). Heterogeneity was moderate for both meta-analyses. Sensitivity analyses confirmed the robustness of the results. Subgroup analyses indicated greater effectiveness in outpatient settings and for extended interventions.
Conclusions
Health-system pharmacist interventions significantly reduce both all-cause and HF-specific hospitalizations in HF patients. Our findings highlight the importance of integrating pharmacists into multidisciplinary teams to improve HF management for in- and outpatients (PROSPERO: CRD42024593583).
