(P077) PHARMACISTS CLINICAL ACTIVITIES AND PATIENT OUTCOMES IN ADULT CONGENTIAL HEART DISEASE PATIENTS

Background: St. Paul’s Hospital (SPH) is a quaternary referral center for adult congenital heart disease (ACHD) patients for British Columbia. ACHD patients are a challenging patient population due their complex cardiac physiology, comorbidities, polypharmacy, and lack of strong treatment evidence. While clinical pharmacists have well-established roles in the management of several cardiovascular conditions, including in heart failure (HF) and atrial fibrillation clinics, the role and benefit of clinical pharmacists in ACHD has not been delineated in the literature.

Due to the complex needs of ACHD patients, SPH incorporated a 0.2 FTE clinical pharmacist (1 day a week) and a HF medication optimization pharmacist on a consult basis to help support the ACHD program. We retrospectively reviewed the activities, contributions, and patient outcomes with the incorporation of a 0.2 FTE clinical pharmacist in an ACHD program.

METHODS AND RESULTS: As a quality improvement initiative, we retrospectively collected data of all consecutive ACHD clinic pharmacist consults between September 1, 2023 to April 27, 2024. Aggregate data that was collected by the clinical pharmacist for these patients was extracted and analyzed. We excluded patients whom the clinical pharmacist was unable to contact. Data is presented using descriptive statistics.

During the study timeframe, clinical pharmacists provided a broad range of clinical services, including 280 best possible medical histories (BPMH), 64 patient-specific drug information consults, generated 29 new prescriptions, and managed warfarin dosing for 23 patients (Table). Pharmacare drug coverage submissions (special authority), refill prescription assessment and refill prescription generation were also common activities of the pharmacist.

Seven ACHD patients received pharmacist-led HF medication optimization services during the studied timeframe, with initiation of spironolactone (n=6) and dapagliflozin (n=3) being the most common interventions. Pharmacist-led HF optimization for all 7 patients is ongoing, with most visits done remotely via telehealth.

Conclusion: Clinical pharmacists provide a wide variety of pharmacy services to SPH ACHD patients, including pharmacist-led medication management (such as HF optimization and anticoagulation medication management), initiation and refill of medication prescriptions. Clinical pharmacists also provided supportive services such as patient-specific drug information consults, BPMH and submissions for Pharmacare medication coverage. Continued research into roles, activities, and effectiveness of clinical pharmacists in medication management in ACHD is warranted.