The role of pharmacists in heart failure management across healthcare settings: a qualitative exploration

Systematic reviews confirm that pharmacist involvement in heart failure (HF) management reduces hospitalisations and improves quality of life (1,2). While the updated NICE guidelines now formally include pharmacists within multidisciplinary team (MDT) (3), their multi-sectoral clinical experiences and the systemic barriers they face remain under-explored.

The primary objective of this study is to explore the professional perceptions, clinical experiences, and perceived barriers of UK-based pharmacists regarding their role in HF management .

An exploratory qualitative study was conducted by using semi-structured interviews. Participants were identified via snowball sampling followed by purposive selection to ensure multi-sectoral representation. 15 interviews were analysed using Braun and Clarke’s six-step thematic analysis (4).

Fifteen UK-registered pharmacists were interviewed, including 9 women and 6 men. The participants possess extensive clinical experience with a mean of 16.5 years (range 4–30 years) in the profession. Notably, 14 participants (93%) were qualified as independent prescribers. Analysis has yielded three preliminary themes:

1.Clinical Role and Medication Management: Pharmacists actively optimised medications, including prescribing, dose up-titration (GDMT), and deprescribing. They played a vital role in patient education and adherence support.

2.Professional Identity and Collaboration: A significant finding was the lack of a well-defined role specifically within primary care settings. Despite formal recognition by NICE, participants, particularly GP pharmacists, reported that their clinical scope remains poorly defined compared to secondary care pharmacists This ambiguity, coupled with identified competency gaps, contributed to reduced clinical confidence in managing complex patients with HF. Participants described their role as a "complementary overlap" with other healthcare providers, highlighting a collaborative synergy rather than professional ambiguity.

3.Barriers and System-Level Opportunities: Fragmented digital infrastructure, lack of funding, and workload pressures were identified as primary barriers. Participants emphasised that pharmacist-led HF clinics represent a key future opportunity if these barriers were to be addressed.

Results suggest that while pharmacists play significant clinical role in HF care, their full potential is hindered by fragmented digital infrastructure, funding gap and organisational constraints . Future initiatives should focus on bridging gaps and optimising strategic access models to fully integrate pharmacists into the HF multidisciplinary landscape.