The impact of health-system pharmacists on hospitalizations in heart failure: a systematic review and meta-analysis

BackgroundPrevious 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. MethodsA 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 Cochranes risk-of-bias tool. Meta-analyses were performed using random-effects models, with odds ratios (OR) as summary measure. Heterogeneity was assessed using the I2 statistic and Cochranes Q test. ResultsIn 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. ConclusionsHealth-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).