# Expanded Role of Primary Care Pharmacists in the Management of Heart Failure

> **NIH VA I50** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2022 · —

## Abstract

Justification. Heart failure (HF) is a common condition in the VA, with high morbidity and mortality.
Accordingly, HF hospitalization and mortality are a focus of VA Safety Analytics for Improvement and Learning
(SAIL). Furthermore, HF medical treatment is complex as there are now four classes of medications known to
independently prolong survival and are recommended to be used together (five for African Americans).
Several medications require titration to recommended doses while monitoring for uncommon but dangerous
side effects. Given the complexity of treatment and the insufficient number of cardiologists to manage this
large patient population, standardized medication initiation and titration of medications by non-physicians has
been tested as an adjunct to current primary care practice of patient aligned care teams (PACT). Pharmacist
medication initiation and titration of medications has been found to improve recommended care in multiple
randomized trials. However, few VA sites have implemented medication initiation and titration of medications
for HF by PACT pharmacists. Hypothesis: Pharmacy medication initiation and titration of HF medications can
be implemented successfully at two sites in VA Palo Alto HCS and will increase recommended use of three
medication classes for Veterans with HF. Gaps Addressed (Knowledge and Practices). A National HF
Dashboard is available to track guideline recommended therapy and shows many patients are not receiving
optimal HF car e. Innovation. The use of PACT pharmacists to provide protocolized care for HF will free up
primary care providers from this work allowing them to increase access to primary care. Given that patients are
often referred to VA Cardiology for this task, pharmacist management can also improve access to VA
Cardiology. Specific Aims 1) Implement pharmacist led protocolized care in PACTs for the initiation and
titration of HF medications at two types of primary care sites. 2) Determine facilitators, barriers, fidelity and cost
of implementation. 3) Demonstrate an impact on recommended HF care and increased access to VA Primary
Care and VA Cardiology as a result of PACT pharmacist management. Project Methods We have partnered
with pharmacy and PACT leadership at VA Palo Alto HCS in their use of PACT pharmacist HF medication
management at one CBOC (Monterey, CA). In this project we will spread this practice to two types of sites: VA
Palo Alto Medical Center based Primary Care Clinic (large) and the VA San Jose CBOC, CA (small).
Implementation Strategies As part of the proposed project we (partnership of the VISN CMO Dr. Godbout
and the QUERI Team) will 1) organize local champions, 2) facilitate spread to the two sites and 3) provide
audit and feedback to PACT pharmacy and primary care leadership. We will bring together local champions
(VA Pharmacy, VA Primary Care and VA Cardiology leadership) who will be shown results over time and will
provide advice on how to modify the implementation for...

## Key facts

- **NIH application ID:** 10425916
- **Project number:** 1I50HX003429-01A1
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Paul Heidenreich
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10425916

## Citation

> US National Institutes of Health, RePORTER application 10425916, Expanded Role of Primary Care Pharmacists in the Management of Heart Failure (1I50HX003429-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10425916. Licensed CC0.

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