2025 Southeastern Residency Conference

TITLE: The Impact of Pharmacist Discharge Education in Preventing Acute Heart Failure Rehospitalizations    
   
AUTHORS: Itea Thomallari, Brian Knott, Brian Morini, Anny MacDonald  
   
BACKGROUND: Congestive heart failure remains a significant cause of hospital readmissions, leading to increased morbidity, mortality, and healthcare costs. Pharmacists are uniquely positioned to intervene in the management of heart failure due to their expertise in medication therapy and patient education. Effective pharmacist-led discharge education can enhance patient understanding of their medications, address barriers to adherence, and improve overall health outcomes. This study aims to evaluate the impact of targeted pharmacist discharge education and the feasibility of implementing such a practice to the pharmacist's daily workflow for acute heart failure patients. 
  
METHODS: This was a single-center, prospective pilot study with pre-posttest design taking place at AdventHealth Winter Park from November 25, 2024 through January 22, 2025. Patients were eligible for enrollment if they met the following inclusion criteria: age ≥ 65 years, NT-pro BNP >900 pg/mL, American College of Cardiology/American Heart Association stage C or D heart failure, New York Heart Association class II-IV heart failure, left ventricular ejection fraction 15-70%, admitted for acute congestive heart failure, and had a pharmacist reviewed admission medication reconciliation review and discharge medication reconciliation review. Patients were excluded if they were currently on renal replacement therapy or had a life expectancy of <6 months. The patients in the post-test phase received a pharmacist reviewed admission medication reconciliation, discharge medication reconciliation as well as pharmacist discharge heart failure counseling. The primary endpoint of the trial was the number of barriers to medication adherence resolved at the time of counseling. The barriers included lack of understanding, cost prohibitive, side effects, or other. Secondary endpoints included the duration of the education sessions, 30-day readmission rates, and patient mortality rate.  
  
RESULTS: A total of 41 patients met the above inclusion criteria, with 13 patients receiving pharmacist counseling in the post test phase and the remaining 28 patients who were reviewed in the pre-counseling arm receiving the pharmacist standard of care. The average number of barriers resolved at the time of counseling was one with a median counseling duration of 20 minutes (IQR 12.5-30). 30-day readmission rates and mortality p-values were 0.5696 and 0.7852, respectively.    
  
CONCLUSION: Targeted pharmacist discharge education improved patients’ understanding of their medication regimens. Although this study was not powered to detect differences in 30-day readmission or mortality rates, addressing these barriers has the potential to influence these outcomes. Further research is needed to evaluate the impact on mortality and hospitalizations. However, integrating this counseling into the pharmacist workflow presents challenges due to its time-intensive nature and the need for additional pharmacist support. While the benefits of counseling are evident, its implementation may not be feasible without additional staffing to manage the increased workload.