Evaluating Pharmacist-Led Heart Failure Transitions of Care Clinic: Impact of Analytic Approach on Readmission Rate Endpoints.

Studies evaluating pharmacist-led transitions of care (TOC) services for heart failure patients reported profound decreases in hospital readmissions. Most studies restricted their analysis to clinic attendees (as-treated analysis), which can introduce selection and immortal time bias. In this study, we evaluated the impact of including only clinic attendees vs all clinic referrals in assessing the effectiveness of a pharmacist-led heart failure transitions of care (PharmD HF TOC) clinic program on 30-day readmissions. This is a retrospective, observational study of patients discharged from a heart failure hospitalization at a large urban academic medical center from August 2016 to December 2018. Primary exposure was the provision of a PharmD HF TOC clinic appointment in the intent-to-treat analysis and the attendance of the clinic in the as-treated analysis. Primary outcome was all-cause readmissions within 30 days of discharge. There were 766 and 1015 patients included in the as-treated and intent-to-treat analyses, respectively. In the as-treated analysis, 30-day all-cause readmissions were significantly lower in the intervention group compared to the control group (12.4% vs 19.6%, P = 0.018). In contrast, the intent-to-treat analysis did not reveal a significant difference in 30-day all-cause readmissions between the intervention group and the control group (18.2% vs 19.6%, P = 0.643). Pharmacist-led heart failure TOC program is associated with a reduction in 30-day all-cause readmissions only when restricting the analysis to clinic attendees. Future studies evaluating the effectiveness of post-discharge TOC services need to carefully consider the biases inherent in the evaluation methods employed.

Hospital emergency preparedness: Push-POD operation and pharmacists as immunizers.

OBJECTIVE: To describe Montefiore Medical Center's participation in a point-of-distribution (POD) exercise in which pharmacists were drilled on the ability to provide immunizations in the face of an emergency. SETTING: New York City on October 9, 2007. SUMMARY: Rapid and appropriate response to a terrorism event can limit morbidity and mortality. After the events of September 11, 2001, the New York City Department of Health and Mental Hygiene (DOHMH) recognized the need to develop a uniform procedure in the case of a potential health disaster. During the fiscal year occurring between September 1, 2006, and August 31, 2007, DOHMH requested that all citywide hospitals participate in a POD drill. All participating hospitals were required to have a team of five health professionals, including one pharmacist, one physician, two nurses, and another member of the institution. The drill was to be conducted within a 4-hour interval to simulate a situation of mass prophylaxis using influenza as a surrogate vaccine or pharmaceutical agent needed in the event of a public health emergency. MAIN OUTCOME MEASURE: Number of health care workers immunized in 4-hour period. RESULTS: During the 4-hour period, the team was able to immunize 942 heath care workers. Predicting a 24/7 operation in the event of a biological terrorism event, the Push-POD operation would have the capacity to immunize 12,000 health care workers-the approximate population of the hospital-in 48 hours. This exercise was replicated for the 2008 influenza program, and the results were identical. CONCLUSION: By allowing pharmacists to expand their scope of practice, New York State will inevitably see a drastic improvement in its adult immunization rates for influenza and pneumococcal vaccinations through greater public awareness and expanded vaccine access.

Angioedema after nonsteroidal antiinflammatory drug initiation in a patient stable on an angiotensin-converting-enzyme inhibitor.

PURPOSE: A case of angioedema associated with the initiation of a nonsteroidal antiinflammatory drug in a patient stable on an angiotensin-converting-enzyme inhibitor is reported. SUMMARY: A 68-year-old African-American man with no known drug allergies and a history of hypertension, benign prostatic hypertrophy, diverticulosis, and gout arrived at the clinic with swelling of the lips and tongue three days after he started taking naproxen 375 mg every eight hours as needed for pain associated with acute gout. He denied urticaria, difficulty breathing, fever, abdominal pain, vomiting, and diarrhea. His other medications included quinapril 10 mg daily (taken for 5 years), tamsulosin hydrochloride 0.4 mg daily, omeprazole 20 mg daily, and colchicine 0.6 mg daily. He had reported smoking approximately 2.5 packs of cigarettes per week and consuming alcohol (one to two drinks) on the weekends. He denied any illicit drug use, drug rash, or seasonal allergies. Naproxen was discontinued, and the patient was treated with prednisone (tapered regimen) and acetaminophen 650-mg tablets, and his angioedema resolved. The Naranjo et al. probability scale revealed that naproxen and quinapril coadministration was the probable cause of the patient's adverse reaction (score of 7). CONCLUSION: A 68-year-old African-American man who had been receiving quinapril for 5 years developed angioedema after initiation of naproxen.

Clevidipine: a novel ultra-short-acting calcium antagonist.

Hypertension is the most common cardiovascular condition in the United States. It can lead to end organ damage and increased mortality risk if it is not properly controlled. In most situations where blood pressure has to be brought down quickly, an intravenous agent with a quick onset of action is often used. Clevidipine is the first third-generation IV dihydropyridine calcium channel blocker that has a high degree of vascular selectivity and an ultra-fast onset and offset of blood pressure lowering effect. In various clinical trials, clevidipine has shown to be safe and effective in controlling acute blood pressure elevations in patients with hypertensive emergencies, preoperative hypertension, and postoperative hypertension. The most common adverse events noted are atrial fibrillation, nausea, headache, and acute renal failure. Overall, clevidipine is a useful addition to available intravenous agents in reducing blood pressure during acute situations. The acceptance of this agent to hospital formularies may ultimately depend on its perceived ease of administration, clinically relevant benefits over other available agents, and acquisition costs.