At the end of 2020, Branko Dukic was experiencing shortness of breath and fatigue, and noticed some problems with his heart. He visited his family doctor who referred him to a cardiologist. That’s how Mr. Dukic began his journey as one of the first patients cared for at the PHARM-HF clinic, embedded within the Heart Function Clinic at St. Paul’s Hospital.
Led by CHÉOS Scientist Dr. Ricky Turgeon, PHARM-HF is the first of its kind in Canada. The brand-new initiative is an outpatient, telehealth-based clinic that provides pharmacist co-management of heart failure medications according to the Canadian Heart Failure Guidelines, with the goal of improving the quality of life and survival of people with heart failure.
“For patients with heart failure, it is important for pharmacists to be involved from the beginning and at every step,” explained Dr. Turgeon, who is also an assistant professor in UBC’s Faculty of Pharmaceutical Sciences. “Different pharmacists will play different roles throughout the heart failure journey.”
Community pharmacists provide longitudinal care and education, and can monitor for and advise on side effects, drug interactions, and access to medications. Inpatient hospital pharmacists help with medication management for patients with heart failure when they are acutely ill in hospital, and can help optimize their medications before discharge so that they are set up for success. And primary care or heart failure pharmacists can do the above and provide additional specialty care, as with the PHARM-HF clinic.
“At all stages, pharmacists work closely with other health care providers by providing treatment recommendations and jointly making treatment decisions with the team,” said Dr. Turgeon.
The patient experience
Mr. Dukic was initially referred for heart bypass surgery because he had three blocked arteries. But just before his surgery, he was sent for an echocardiogram. He said, “The echocardiogram revealed that I also had heart failure. Because of this new diagnosis, my surgery was postponed and I was referred to St. Paul’s Heart Function Clinic.”
During his first appointment at the Heart Function Clinic, Mr. Dukic received some guidance and literature about his condition and what he should be doing at home. He was also prescribed some medication to help treat his heart failure. The clinic contacted Mr. Dukic regularly to review how he was feeling and adjust his medication and, in July, he became a patient in PHARM-HF, with Dr. Turgeon as his pharmacist.
“Medications are at the centre of how we treat heart failure, and pharmacists are experts in medications,” stated Dr. Turgeon. “The traditional role of pharmacists in the care of people with heart failure includes getting an accurate list of medications that patients are taking, ensuring access and adherence to medications, providing education on how to take medications, and managing side effects and drug interactions.”
Today, an increasing number of pharmacists are using their expertise to take more direct roles in patient care for conditions like heart failure, high blood pressure, and diabetes, including starting, changing, and stopping medications, ordering and monitoring bloodwork, and managing side effects.
Mr. Dukic began having appointments with Dr. Turgeon every two weeks to discuss his prescription and alter his medications to drugs and dosages that would suit him better.
“My condition has significantly improved since the start of the year. At the end of January, I would get short of breath just walking around my apartment and, when I was in bed, I would sweat and wake up tired in the morning,” recalled Mr. Dukic. “Once I started treatment, my ability to walk began to improve. At the beginning, I could go maybe a couple of blocks before I had to stop because of chest pain and shortness of breath. But every week, I started to feel better.”
It took Mr. Dukic some time to get used to one of his medications – beta blockers – and dose changes. He disclosed how, when he first started taking the drug, it sometimes felt like his heart was being squeezed. But with Dr. Turgeon by his side, closely monitoring and adjusting his prescription, Mr. Dukic knew he was in good hands.
“My experience with PHARM-HF was excellent. All that I needed to understand was presented to me well. Dr. Turgeon even gave me his cell phone number so that I could call him whenever I needed to,” said Mr. Dukic. “My last appointment with Dr. Turgeon was in September and, any day now, I am expecting a call to schedule my heart bypass surgery.”
Becoming a patient with PHARM-HF
Patients from anywhere in B.C. can be referred to PHARM-HF by a Providence Health Care cardiologist. During their first appointment at the clinic, the pharmacist and patient chat about the patient’s quality of life, treatment preferences and values, and medication options. Then, together, they make a plan.
“After their initial appointment, patients are followed by telehealth every one to two weeks to make changes to their medications, and monitor and manage side effects,” explained Dr. Turgeon. “Once patients are receiving the optimal medications for them — usually after an average of two to three months — they are discharged from PHARM-HF with continued follow-up by their cardiologist and primary care team.”
Since its launch at the end of January 2021, PHARM-HF has been extremely well received by both patients and other members of the health care team, with a large increase in referrals since the summer. The growth in demand highlights the need for this sort of initiative within Providence Health Care and throughout B.C. Dr. Turgeon’s team is now exploring opportunities to extend the reach of PHARM-HF via research and community partnerships.
Dr. Turgeon is a busy guy. On top of his work at CHÉOS, UBC, and PHARM-HF, he is the pharmacist contributor for the HeartLife Foundation’s recently launched HeartLife Academy. Founded by Dr. Jillianne Code and Marc Bains, both transplant recipients and heart failure survivors, the academy will provide educational materials produced by and for heart failure patients. Don’t miss their upcoming courses on cardiac rehab, heart failure medications, and mental health!