Enlisting Pharmacists and Nurse Practitioners in Medication Management Can Fill Critical Gaps in Heart Failure Care, Save Lives, and Reduce Hospital Stays

A novel economic model projects that patients with heart failure would live longer lives and spend less time in hospital by expanding heart failure care to include pharmacist- and nurse practitioner-led medication management. Findings from the novel studyopens in new tab/window in the Canadian Journal of Cardiologyopens in new tab/window, published by Elsevier, demonstrate the cost-effectiveness of this service and offer a roadmap towards improved patient outcomes and a stronger and more sustainable healthcare system.

Heart failure affects approximately 860,000 Canadians, is associated with reduced survival and quality of life, and is the third leading cause of hospitalization in the country. Heart failure with reduced ejection fraction (HFrEF) accounts for approximately half of these cases.

Despite high-quality evidence supporting the benefits of guideline-directed medical therapy (GDMT) for patients with HFrEF, which entails the rapid initiation of four distinct classes of medication collectively known as quadruple therapy, use of these medications remains suboptimal. This is in part due to inadequate access to heart failure specialists and clinics for many Canadian patients living with HFrEF. This high unmet need underscores the importance of alternative models that expand beyond physician-led GDMT management.

“Heart failure is a serious medical condition that has several effective medications that are underused across Canada,” says lead investigator Ricky Turgeon, BSc(Pharm), ACPR, PharmD, Faculty of Pharmaceutical Sciences, University of British Columbia. “Pharmacists and nurse practitioners are important members of the healthcare team who can help to improve medication use for heart failure.”

The researchers evaluated whether getting pharmacists and nurse practitioners to initiate and manage heart failure medications would be good value for money for the healthcare system by comparing two different scenarios using an economic model.

In the first scenario, patients with heart failure received the usual care currently experienced by most British Columbians with heart failure. In the second scenario, patients with heart failure received the usual care plus additional medication management from pharmacists and nurse practitioners. The investigators then modelled what would happen to these patients over time and tracked how long they would live, how often they would be hospitalized, and how much healthcare resources they would need.

It was estimated that within the first year of implementation, this added service would save approximately 10 lives and prevent 25 hospitalizations per every 1,000 patients who received the pharmacist- or nurse practitioner-led intervention.

“While this service would require additional funding, we demonstrated that this investment would be well justified given what the Canadian healthcare system is generally willing to pay,” notes Dr. Turgeon. “The size of this benefit was far beyond what was anticipated. As a pharmacist caring for people with heart failure, I find these results genuinely empowering. They show that we play an important role in improving patients' lives while also easing pressure on the healthcare system. We have the evidence; now we need to implement this approach.”

By quantifying the clinical and economic impacts of these additional medication management services, this study provides healthcare system planners with the insights needed to effectively address persistent gaps in care for heart failure patients.

Co-lead investigator Kelly Mackay, MA, Cardiac Services BC, Provincial Health Services Authority, comments, “Our research offers a roadmap to improving patient outcomes while strengthening the sustainability of our health system. The research also provides Cardiac Services BC with the evidence and innovation needed to drive meaningful system change.”

“Expedited and increased access to quadruple therapy has the potential to save lives and reduce some of the pressures in British Columbia’s hospitals. We believe this model could also be successful in other Canadian provinces. We’re thrilled that this research presents such an effective—and feasible—way for more heart failure patients to receive this gold-standard treatment,” concludes co-investigator Nathaniel Hawkins, MBChB, MD, MPH, Cardiac Services BC, Provincial Health Services Authority, and Division of Cardiology, University of British Columbia.

Notes for editors

The article is “Cost-effectiveness of Pharmacist and Nurse Practitioner-led Medication Management for Heart Failure With Reduced Ejection Fraction,” by Blair J. MacDonald, PharmD, Chloe Wu, MSc, Nathaniel M. Hawkins, MBChB, MD, MPH, Fritha Munday, MPH, Kelly Mackay, MA, and Ricky D. Turgeon, BSc(Pharm), ACPR, PharmD (https://doi.org/10.1016/j.cjca.2026.05.001opens in new tab/window). The article appears online in the Canadian Journal of Cardiology, published by Elsevier.

The article is openly available at https://onlinecjc.ca/article/S0828-282X(26)00397-1/fulltextopens in new tab/window.

Full text of the article is also available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474 or [email protected]opens in new tab/window to request a PDF of the article or more information. To speak to the authors, journalists should contact:

Cardiac Services BC media contact

Kendall Soper, Communications Officer

Provincial Health Services Authority

[email protected]opens in new tab/window

UBC Faculty of Pharmaceutical Sciences media contact

Blair J. MacDonald, PharmD, PhD candidate

UBC Faculty of Pharmaceutical Sciences

[email protected]opens in new tab/window

This work was supported by Cardiac Services BC, Michael Smith Health Research BC, and the Canadian Institutes of Health Research.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiologyopens in new tab/window (CJC) is an international, peer-reviewed journal that disseminates new knowledge in cardiology and cardiovascular science. It is the preferred Canadian cardiovascular medicine peer-reviewed publication and is an official journal of the Canadian Cardiovascular Societyopens in new tab/window(CCS). The CJC publishes original reports of clinical and basic research relevant to cardiovascular medicine, as well as practice guidelines, editorials, review articles, and case reports. www.onlinecjc.caopens in new tab/window

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCSopens in new tab/window is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit www.ccs.ca/enopens in new tab/window.

About Elsevier

Elsevier is a global leader in advanced information and decision support. For over a century, we have been helping advance science and healthcare to advance human progress. We support academic and corporate research communities, doctors, nurses, future healthcare professionals, and educators across 170 countries in their vital work. We help impact makers achieve better outcomes with research and clinical-grade solutions built on the world’s leading evidence-based scientific and medical content, precision AI, and expert human assessment. We champion inclusion and sustainability, working with the communities that we serve. The Elsevier Foundationopens in new tab/window supports research and health partnerships around the world.

Elsevier is part of RELXopens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information, visit www.elsevier.com and follow us on social media @elsevierconnect.