Care transitions in elderly heart failure patients: current practices and the pharmacist's role

Abstract

Objective: To provide an up-to-date review of current care transitions in elderly heart failure (HF) patients and assess the role of the pharmacist in improving patient care.

Data source: A PubMed search of articles in the English language published between 1995 and May 2013 was done using a combination of the following words: discharge counseling, elderly, heart failure, multidisciplinary team, pharmacist, pharmacy, readmission, transition of care.

Study selection/data extraction: Relevant original studies, review articles, and guidelines were assessed for current practices in HF transitions of care. References from the above literature were also evaluated for relevance. Articles were selected for inclusion based on relevance to the topic, detailed methods, and clear, comprehensive results.

Data synthesis: The incidence of HF is rapidly increasing, and emphasis has been placed on reducing readmissions. Although present practices are primarily nurse-led, pharmacists are in a key position to educate patients through multidisciplinary teams, discharge counseling, and medication reconciliation. Because of concerns about pharmacist provider status and reimbursement, pharmacists should identify areas in their practices where they can intervene and improve patient care to reduce readmissions.

Conclusion: Pharmacists are an integral part of the multidisciplinary team in optimizing care for elderly HF patients to prevent readmissions.

Keywords: ACE = Angiotensin-converting enzyme; ACS = Acute coronary syndrome; ADE = Adverse drug event; APN = Advanced practice nurse; CHF = Congestive heart failure; CV = Cardiovascular; Discharge counseling; Geriatrics; HF = Heart failure; Heart failure; Multidisciplinary team; Pharmacy; Readmission; TPE = Therapeutic patient education; Transitions of care.