Final Program - Canadian Society of Hospital Pharmacists

18
Warm, Cold, Wet, Dry: An Approach to Acute Heart
Failure
SHERI L. KOSHMAN, BSCPHARM, PHARMD, ACPR, DIVISION OF
CARDIOLOGY, UNIVERSITY OF ALBERTA, EDMONTON, AB
Heart failure (HF) is a leading cause of both morbidity and
mortality in Canada. It is estimated that 50% of patients with HF
will die within 5 years. HF is one of the top reasons for
hospitalizations and re-hospitalization, resulting in significant costs
to the healthcare system.
Acute heart failure, now termed acute heart failure syndrome
(AHFS) secondary to its varied pathophysiology, etiology and
clinical presentation, is characterized by new, gradual, or rapid
worsening of signs and symptoms of HF requiring urgent therapy.
General management principles include clinical assessment
(evidence of congestion – wet or dry; evidence of low perfusion
– warm or cold), identification of etiology and precipitants,
symptom control and prevention of death.
Treatment of AHFS is limited secondary to the paucity of clinical
data of beneficial therapies. Traditional therapies include diuretics,
vasodilators and inotropes. While these agents have some data
in terms of symptoms and surrogates, they have limited hard
clinical outcome data supporting their use. More modern
therapies include agents such as nesiritide and tolvaptan. These
agents also have limited data supporting improvement in patient
outcomes for AHFS.
Pharmacists play an important role in the management of
patients with AHFS as well as in the prevention of rehospitalizations.
Identification and avoidance of precipitants,
medication teaching and adherence and utilization of evidencebased
medicines are all areas that pharmacists can improve care
in this high-risk population.
Goals and Objectives
1. To overview the pathophysiology of acute heart failure
syndrome (AHFS)
2. To described the clinical evaluation of a patient with AHFS
3. To review pharmacotherapy strategies for the treatment and
prevention of AHFS
Self-Assessment Questions
1. What is the spectrum of clinical presentation in patients
presenting with AHFS?
2. What key pharmacotherapeutic strategies are available to treat
AHFS and what are their impacts on patient outcomes?
3. What strategies can pharmacist employ to prevent rehospitalizations
secondary to AHFS?
Making the Case for a National Drug Plan: Access,
Cost and Health Outcomes
MARC-ANDRÉ GAGNON, PHD, ASSISTANT PROFESSOR, SCHOOL OF
PUBLIC POLICY AND ADMINISTRATION AT CARLETON UNIVERSITY (OTTAWA),
OTTAWA, ON
The purpose of this session is to demonstrate that a public and
universal drug insurance plan covering all prescription drug costs,
based on first-dollar coverage, is economically possible and
socially desirable in terms of equity and drug safety. It will also
demonstrate that, in an appropriate institutional environment, it
would be the most economically efficient drug insurance plan for
all Canadians.
A public drug insurance plan forms an integral part of a country’s
pharmaceutical policies. The plan must tie together social policies
designed to provide a minimum of well-being for all citizens,
health policies designed to optimize public health, industrial
policies aimed at attracting foreign investment, intellectual
property policies, as well as tax policies designed to ensure
greater fairness in redistributing wealth. A drug insurance plan is
not only a way to compensate for or reimburse drug expenses,
but also a way to control costs for buyers by giving them
monopsony bargaining power when dealing with powerful
transnational pharmaceutical companies. In fact, a drug insurance
plan that includes a drug assessment process can also help
distinguish between drug products in order to ensure the quality,
safety and cost-effectiveness of prescription drugs. The
complexity of these various aspects of pharmacare must be
considered in order to determine the best drug insurance plan to
meet the common goals of a community.
The main argument that is typically made against the
establishment of universal Pharmacare is economic in nature.
The presentation explains that a universal drug plan providing
first-dollar coverage, established alongside a rigorous drug
assessment process, would not only ensure greater fairness in
accessing medication and improve drug safety, but would also
help contain the inflationary costs of drugs. The economic
argument in favour of such a program is loud and clear, since
Canadians could save between 10% and 42%—up to $10.7
billion—of total drug expenditures, while improving access and
health outcomes.
After presenting the most important issues about access to
medications and cost-containment, the presentation will explore
different scenarios for implementing a national drug plan, based
on how we would want to use the drug plan to serve purposes
of innovation policy in the pharmaceutical sector.
Goals and Objectives
1. To provide an understanding of the many roles and functions
of Pharmacare in a community.
2. To provide an in-depth analysis of the flaws in the current
blend of existing public and private drug plans.