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Utility of a pharmacist-managed Anticoagulation Program in patients with congenital heart disease

Published online by Cambridge University Press:  08 September 2023

Meredith J. O’Neil Open the ORCID record for Meredith J. O’Neil [Opens in a new window] ,
BreAnn N. Garr ,
Jenna M. Faircloth ,
Julie A. Ciambarella ,
Adam M. Lubert Open the ORCID record for Adam M. Lubert [Opens in a new window] ,
Nicole L. Nelson  and
David S. Cooper
Meredith J. O’Neil*
Affiliation:
Division of Pharmacy, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
BreAnn N. Garr
Affiliation:
Division of Pharmacy, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Jenna M. Faircloth
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, TX, USA
Julie A. Ciambarella
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Adam M. Lubert
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Nicole L. Nelson
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
David S. Cooper
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
*
Corresponding author: M. J. O’Neil; Email: meredith.oneil@cchmc.org
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Abstract

Background:

Warfarin remains the preferred anticoagulant for many patients with CHD. The complexity of management led our centre to shift from a nurse-physician-managed model with many providers to a pharmacist-managed model with a centralized anticoagulation team. We aim to describe the patient cohort managed by our Anticoagulation Program and evaluate the impact of implementation of this consistent, pharmacist-managed model on time in therapeutic range, an evidence-based marker for clinical outcomes.

Methods:

A single-centre retrospective cohort study was conducted to evaluate the impact of the transition to a pharmacist-managed model to improve anticoagulation management at a tertiary pediatric heart centre. The percent time in therapeutic range for a cohort managed by both models was compared using a paired t-test. Patient characteristics and time in therapeutic range of the program were also described.

Results:

After implementing the pharmacist-managed model, the time in therapeutic range for a cohort of 58 patients increased from 65.7 to 80.2% (p < .001), and our Anticoagulation Program consistently maintained this improvement from 2013 to 2022. The cohort of patients managed by the Anticoagulation Program in 2022 included 119 patients with a median age of 24 years (range 19 months–69 years) with the most common indication for warfarin being mechanical valve replacement (n = 81, 68%).

Conclusions:

Through a practice change incorporating a collaborative, centralized, pharmacist-managed model, this cohort of CHD patients on warfarin had a fifteen percent increase in time in therapeutic range, which was sustained for nine years.

Keywords

WarfarinanticoagulationpharmacistpediatricCHD
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 3 , March 2024 , pp. 628 - 633
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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