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Acute heart failure (AHF) is a common cause of hospitalization, particularly among older individuals, and has high mortality and readmission rates. Adherence to guideline-directed medical therapy (GDMT) is crucial for improving outcomes in heart failure (HF) patients, as non-adherence can lead to exacerbations and adverse outcomes. However, studies have shown that medication non-adherence rates among HF patients can be as high as 70%. Various factors contribute to non-adherence, including patient circumstances, treatment-related factors, and healthcare system and payer factors. Adherence interventions, such as patient education, medication regimen management, and reminders, have been shown to improve medication adherence and reduce mortality and hospital readmissions in HF patients. Improving adherence to GDMT is essential for improving AHF outcomes, and further research is needed to identify effective approaches to enhance medication adherence. [Extracted from the article]

Background: Pharmacists are key members of multidisciplinary heart failure (HF) clinics; however, there is variation in their roles and activities. This study aimed to: (1) define current roles of HF clinic pharmacists and (2) develop a consensus‐based list of key activities for HF clinic pharmacists. Methods: In part 1, we invited Canadian and American HF clinic pharmacists to complete a survey on activities currently performed in the HF clinic. Part 2 consisted of a three‐round modified Delphi study including only Canadian participants to define key activities for ambulatory HF pharmacists among 44 candidates. In each round, participants rated a list of candidate activities based on importance and priority on a 9‐point Likert scale. Consensus was reached for inclusion when ≥75% of participants rated both criteria ≥7, or exclusion when both criteria ≤6. Participants received personal responses alongside aggregate ratings after each round to facilitate attainment of consensus. Results: Eighty‐four pharmacists participated in part 1, and 29 (of 55 invited) participated in part 2 (24 retained for all three rounds). Current pharmacist activities were similar between American and Canadian participants, with an emphasis on patient assessment and clinical activities including modification of HF‐specific pharmacotherapy. The final consensus‐based list included 32 activities, with high priority placed on activities involving optimization of medications for HF and common comorbidities, engaging in shared decision‐making, assessing adherence, reviewing lab tests, and assessing and modifying medications due to pharmacokinetic/pharmacodynamic parameters, which closely mirrored activities in current practice. Conclusion: Current activities of ambulatory HF pharmacists are largely consistent within North America, focusing on patient assessment and HF‐specific pharmacotherapy modification. Our consensus‐based list defined 32 activities integral to the future role of pharmacists in HF clinics, which builds upon activities being currently performed. This provides a framework to standardize and expand the scope of practice for clinical pharmacy services in HF clinics. [ABSTRACT FROM AUTHOR]

Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Ivabradine and empagliflozin Ivabradine and spironolactone Spironolactone and empagliflozin Empagliflozin only B Part II: Oral anticoagulants in patients with antiphospholipid syndrome. b You are evaluating a patient with a history of arterial thrombus for a potential diagnosis of antiphospholipid syndrome (APS). Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. Catastrophic APS Obstetric APS Primary APS Secondary APS A 38-year-old man with secondary APS presents with recurrent arterial thrombotic event while on adequate warfarin therapy. [Extracted from the article]

Pharmacists play a crucial role in the management of heart failure, contributing to patient-specific, facility-specific, and population services. They are key stakeholders in ensuring the optimization of guideline-directed medical therapy (GDMT) for heart failure patients, including medication selection, optimization, and adherence. Studies have shown that involving pharmacists in the care team leads to higher rates of achieving GDMT, resulting in lower mortality and hospitalization rates. However, there are challenges in embedding pharmacists in all clinical settings globally, including training, access, and scope of practice. Health institutions, clinicians, and organizations need to advocate for the inclusion of pharmacists in heart failure care and support their training and development. [Extracted from the article]

As health care transitions to value‐based care, it is more critical than ever to emphasize and quantify the impact on patient outcomes made by inpatient/acute care pharmacists and pharmacist extenders as members of the interprofessional care team. Thus, the American College of Clinical Pharmacy (ACCP) took to task the development of quality measures that were broadly applicable to the diverse inpatient/acute care landscape and important for standardizing practice, measuring impact, contextualizing benefit within the health care landscape, and allowing benchmarking within and between institutions. A framework was established by the writing committee of this paper in order to develop quality measures in a methodical manner. The resulting process led the writing committee to devise 31 foundational quality measures to be used in efforts to champion the pharmacist's role in achieving the quadruple aims in health care. Application and evaluation of quality measure performance as well as limitations and future implications of the measures are addressed to further highlight the evolving role of the inpatient/acute care pharmacist and pharmacist extender. [ABSTRACT FROM AUTHOR]

Anticoagulation of patients treated with the Impella percutaneous mechanical circulatory support (MCS) devices is complex and lacks consistency across centers, potentially increasing the risk of complications. In order to optimize safety and efficacy, an expert committee synthesized all available evidence evaluating anticoagulation for patients receiving Impella support in order to provide consensus recommendations for the management of anticoagulation with these devices. The evidence synthesis led to the creation of 42 recommendations to improve anticoagulation management related to the use of the Impella devices. Recommendations address purge solution management, intravenous anticoagulation, monitoring, evaluation and management of heparin‐induced thrombocytopenia (HIT), and management during combination MCS support. The use of a heparinized, dextrose‐containing purge solution is critical for optimal device function, and a bicarbonate‐based purge solution may be an alternative in certain situations. Likewise, intravenous (ie, systemic) anticoagulation with heparin is often necessary, although evidence supporting the optimal assay and target range for monitoring the level of anticoagulation is generally lacking. Patients treated with an Impella MCS device may develop HIT, which is more difficult to evaluate and treat in this setting. Lastly, the use of Impella with extracorporeal membrane oxygenation or for biventricular support creates additional anticoagulation challenges. [ABSTRACT FROM AUTHOR]

Background: The ClotCare Online Information Resource ("ClotCare") was established in 2000 as an interactive patient education service. In 2003, its scope of service was expanded to include clinicians and the general public, and an editorial board was added to facilitate dissemination of new information. By 2008, the site had achieved national and international recognition. Methods: Website use statistics and an online survey were used to assess geographic reach and clinical impact in 2010. Results: The site experienced an annual growth of over 40% (with the use doubling every 2 years). ClotCare answered over 1000 questions per year, web traffic exceeded 500 000 "hits" per month and more than 5000 individuals subscribed to the email list serve. Of the 826 individuals who responded to the survey, 55% subscribed to the email list serve, 58% were health care professionals, 31% were patients, and 11% were "individuals seeking information on blood clots and related issues". United States residents comprised 87% of respondents; the others resided in 20 different countries. Data from completed surveys revealed that 367 of 412 health care professionals (89%) and 259 of 298 patients (87%) could identify a specific change in practice that they had made due to information from ClotCare. Among the 295 "frequent users," 94% to 98% agreed or strongly agreed that ClotCare increased their knowledge, provided valuable information, provided trusted information, provided a valuable service, and is among the top five resources utilized for information on blood clots and related treatments. Conclusions: ClotCare substantially altered the actions of both health care professionals and patients. These outcomes have been achieved through web‐based education and information sharing as well as "on demand" responses to questions. ClotCare is a widely used resource that is highly valued. [ABSTRACT FROM AUTHOR]

This white paper evaluates the current and future state of clinical pharmacist‐led precision medicine initiatives, focusing on an overview of pharmacogenomics (PGx) in three key areas: clinical practice, education, and research. These key facets are described in detail, followed by a review of potential and perceived barriers concerning PGx and recommendations for the clinical pharmacist's role in overcoming these barriers. This paper reviews the current state of clinical pharmacist‐led precision medicine and presents a vision for the future of pharmacy practice in this quickly evolving field. [ABSTRACT FROM AUTHOR]

Despite advances in the management of heart failure ( HF), quality of life and other outcomes remain suboptimal for many patients. Anemia and iron deficiency are comorbidities associated with adverse outcomes, although their pathophysiology in the setting of HF is not entirely understood. Anemia and iron deficiency may exist independently and may be a consequence of the systemic inflammatory state characterized by chronic HF. However, it is unclear whether serum hemoglobin concentrations and other hematologic parameters serve as markers for the severity of disease or represent novel therapeutic targets. Research in this area has focused primarily on therapies known to be effective for these conditions in other chronic disease states with similar pathophysiologic features (e.g., end-stage renal disease). Despite its many practical advantages, minimal evidence exists to support the use of oral iron supplementation in this setting. In contrast, intravenous iron has been the subject of several recent investigations, demonstrating improvements in both surrogate and clinical end points, although benefits seem to be the most substantial in patients with concomitant anemia. Erythropoietin-stimulating agents demonstrated early promise in retrospective analyses and small prospective trials, but their benefit was outweighed by a lack of improvement in clinical outcomes and an excess number of thromboembolic events in the largest trial of patients with anemia and HF to date. For acute symptomatic anemia, blood transfusion may be considered, although few trials have included patients with HF, and caution must be exerted in those who are hemodynamically unstable. Based on the currently available evidence, treatment of iron deficiency appears to confer benefit in patients with HF, whereas strategies aimed at improving hemoglobin alone do not. Included is a review of the pathophysiology of these conditions in the setting of HF, clinical trials evaluating pharmacologic therapy, and recommendations for management. [ABSTRACT FROM AUTHOR]

More than 1 million people in the United States experience an acute coronary syndrome ( ACS) every year, and almost 600,000 undergo percutaneous coronary intervention ( PCI) for treatment of cardiovascular disease. There is a large amount of evidence-based literature to guide appropriate management of these patients. There have been a number of advances in the treatment of these patients over the last several years. Due to the large amount of rapidly available literature concerning the care of patients with ACS or undergoing PCI, clinicians can often find it difficult to keep up with the information needed for optimizing care of these patients. Therefore, we provide the second update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. The initial update was published in Pharmacotherapy in 2007 and also included bibliographies concerning management of patients undergoing PCI. A number of guidelines and practice-changing literature have been published since the update in 2007. Specific areas included in this review are updated summaries of clinical practice guidelines and clinical trials of anticoagulants, antiplatelets, platelet aggregation testing, pharmacogenomics testing in patients taking clopidogrel, clopidogrel loading dose comparisons, clopidogrel and proton pump inhibitor drug interactions, the impact of bleeding in ACS, and statins. As with previous versions of this document, we hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease. [ABSTRACT FROM AUTHOR]