Pharmacists play a critical role in managing patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a study presented at the National Association of Specialty Pharmacy (NASP) inSPire2026 meeting. Namarta Kalia, PharmD, BCPS, BCGP, CSP, a clinical pharmacist at Shields Health Solutions, highlighted the impact of pharmacist interventions in a single-center analysis of 439 adults enrolled in a health-system specialty pharmacy (HSSP) program.
Pharmacist Interventions in ATTR-CM Care
Over a 6-month period, pharmacists completed 68 interventions: 27 for refill coordination (40%), 21 for symptom escalation (31%), 18 for adherence counseling (26%), and 2 in other categories (3%). The study found that 90% of symptom escalations flagged by pharmacists were accepted by prescribers, leading to timely clinical responses and therapy adjustments.
Of the 21 symptom escalations, 12 (57%) resulted in changes to heart failure therapies, 7 (33%) led to accelerated clinic appointments, and 2 (10%) prompted emergency department evaluations. The mean proportion of days covered, a measure of medication adherence, was 98%.
Risk-Based Approach to Patient Care
Kalia explained that her team follows a risk-based approach, with pharmacists handling medication access, refill timing, and adherence concerns. Clinicians are involved for clinically meaningful changes, such as worsening shortness of breath, edema, or significant weight gain, which could indicate fluid overload.
Identifying trends helps, as a single episode may not require escalation. Kalia schedules follow-up calls to monitor recurring symptoms, sharing patterns with clinicians for further evaluation. This proactive monitoring prevents significant clinical issues and hospital admissions.
Impact of Pharmacist Interventions
The relatively low intervention rate reflects a stable, engaged patient population, not undercaptured interventions. Kalia emphasized that these interventions are impactful, allowing pharmacists to address subtle changes reported by patients before they escalate.
This approach is particularly relevant in ATTR-CM care, where disease-stabilizing therapies are generally well-tolerated and do not require frequent dose adjustments or lab monitoring. By focusing on proactive monitoring, pharmacists can optimize patient outcomes and reduce emergency interventions.