Heart failure and associated cardiovascular diseases are
undeniably some of the most serious conditions currently faced by the population
in Ireland and abroad with an estimated 17.7 million deaths worldwide, and 80%
of those being due to heart attacks and stroke1 (World Health
Organisation, 2017). According to the HSE2 around 90,000
people in Ireland suffer from some form of heart failure with most patients
being in their 70s. Not only is heart failure one of Irelands greatest causes
of death but it is also the cause of 20,000 admissions to Irish hospitals each
year (Health
Service Executive , 2017). The prevalence of heart failure is
also set to rapidly increase due to an aging and ever-expanding population
although currently there are over 10,000 new cases each year3 (Irish Heart
Foundation , 2017).

Not only does the syndrome have a direct and severe impact
on the lives of those people who suffer from it but its rampant effects also
extend into the economic environment in Ireland. The pathophysiology of this
condition is characterised by numerous traits such as high morbidity, high
mortality, frequent readmission to hospitals, and a great reliance on informal
care which in turn creates a great burden for not only the Irish but also the
global economy7 (KennellyB., 2014). According to a 2015 study carried out by The
Heartbeat Trust, the annual cost of Heart failure is around €660 million with
€158 million being attributed to direct costs with primary care related
expenditure accounting for 25% of this figure and drug costs accounting for a
further 16%8 (The Heartbeat Trust, 2015).

Heart failure can be described as a complex clinical
syndrome in which the heart fails to pump blood around the body at a sufficient
rate to meet the body’s metabolic demands. Symptoms of heart failure include dyspnoea,
fatigue and weakness, and oedema in the legs2  (H.Lund L, 2017) (Health
Service Executive , 2017)6. Depending on ejection
fraction, natriuretic peptide levels, and presence of structural heart disease
and diastolic dysfunction, heart failure can be split into three subtypes.
These are heart failure with reduced ejection fraction (HFrEF), heart failure
with preserved ejection fraction (HFpEF), and heart failure with mid-range
ejection fraction (HFmrEF)6 (H.Lund L, 2017). Due to the broad aetiology of heart
failure, there are numerous treatments available in its management. Most commonly
used drugs prescribed for those patients suffering from heart failure include
diuretics such furosemide to increase salt and water excretion, angiotensin converting
enzyme inhibitors such as enalapril which reduce vascular resistance, Beta
blockers such as bisprolol, and aldosterone antagonists such as losartan (Health
Service Executive , 2017) (Rang H P)

Due to the condition’s severity and great number of patients
suffering from it, it is imperative for pharmacists as primary care providers
to actively contribute in the management and care of such patients. Heart
failure is a condition which can be treated through the usage of
pharmacological agents as well as lifestyle changes, and surgery allowing the
patient to live their life normally2 (Health Service Executive , 2017) . There
has been evidence brought up that a multidisciplinary approach to patient
management provides an improvement to the patient’s clinical condition with pharmacists
being vital members of this team4 (W.M. Cheng J, 2014). Studies such as the one
conducted by A. Warden et al5 (WARDEN, 2013) showed significant reductions in
the rate of readmission of heart failure patients with an increase in patient
satisfaction when a pharmacy managed program was in place for provision of
education and discharge instructions for these patients.


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