Paul Forsyth

• MPharm, MSc (Primary Care), FRPharmS (Consultant)
• Cardiology Consultant Pharmacist at Golden Jubilee National Hospital

Meta-analysis of small trials suggests that pharmacist-led collaborative review and revision of medical treatment may improve outcomes in heart failure. We studied patients with left ventricular systolic dysfunction in a cluster-randomized controlled, event driven, trial in primary care. We allocated 87 practices (1090 patients) to pharmacist inter...

Peripartum cardiomyopathy (PPCM) is a potentially life‐threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysio...

Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined...

Healthcare values are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. However, their ability to honor these values is significantly determined by the nature of the system in which they work. Th...

Background Globally, health professionals are advancing roles to meet growing healthcare demands. Pharmacists are increasingly required to deliver autonomous, holistic, highly complex advanced care. Preceptorship could be used more widely to support delivery of advanced pharmaceutical care. Aim The aim of this study was to formulate statements des...

Introduction Episodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or a...

Introduction Pharmacist involvement in clinical assessment or examination has recently come into the focus in the United Kingdom with the transition of the pharmacy workforce to prescribers. Clinical assessment starts with the collection of information on an individual’s past medical history and clinical presentation, and the interpretation of test...

Background: Previous evidence has established the role of pharmacists in heart failure (HF) care. However, the specific role of health-system pharmacists within in- and outpatient settings for HF patients has been left unexplored. This systematic review and meta-analysis aimed to evaluate the impact of health-system pharmacy interventions on all-ca...

Timely diagnosis of heart failure (HF) and rapid optimisation of guideline-directed medication therapy (GDMT) improves patients qualities of life, reducing mortality and morbidity. Previous papers describe the role of pharmacists in medication optimisation, but not in the diagnosis of HF. To describe the development, implementation, and evaluation...

Objective Pharmacist-led research is key to optimizing medicines use and improving pharmacy services, yet it is not yet widely embedded into careers. This study aims to identify predictors of confidence in meeting the research learning outcomes in the Royal Pharmaceutical Society (RPS) Post-Registration Foundation and Core Advanced curricula, to pr...

Background & Aims Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis. Methods Glasgow regional health records (2009-2016) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with ha...

(1) Background: As part of the Scottish Government’s five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experiences with this new ser...

(1) Background: As part of the Scottish Governments five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experience of this new service...

Objective Heart failure remains a key public health priority across the globe. The median age of people with heart failure admitted to hospital in the UK is 81 years old. Many such patients transcend the standard interventions that are well characterised and evidenced in guidelines, into holistic aspects surrounding frailty, rehabilitation and soci...

Introduction Research drives safe and cost-effective practice, innovation and quality care. The national workforce directive calls for integration of research into healthcare roles1; however, pharmacist research is typically undertaken by a minority of highly motivated individuals2. Inclusion of research learning outcomes in all three Royal Pharmac...

Introduction The burden of heart failure is underestimated, and it has a long average inpatient stay. Many healthcare institutions have trialled the outpatient administration of intravenous diuretics, which demonstrated a reduction in hospitalisation, however the reasons for not implementing this service model more widely remain unknown. Aim The a...

Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication dispensing contribute to such delays. To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the d...

Heart failure (HF) is a growing global public health problem affecting at least 26 million people worldwide. The evidence-based landscape for HF treatment has changed at a rapid rate over the last 30 years. International guidelines for the management of HF now recommend the use of four pillars in all patients with reduced ejection fraction: angiote...

Introduction Workforce pressures in general practice have led to Scottish Government initiatives to integrate pharmacy teams into general practice. The focus is completion of prescribing management-related activities releasing general practitioner time for patient-focused workload.1 Activities include medicines reconciliation from immediate dischar...

Objectives The four nations of the United Kingdom (UK) have endorsed a new curriculum and credentialing process for consultant pharmacists. This study aimed to measure the self-reported consultant-level practice development needs of pharmacists across the UK. Methods The study was a cross-sectional electronic survey. Inclusion criteria were: pharm...

Background: With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of care...

Heart failure rarely exists in isolation: patients frequently have other diagnoses which require treatment. Many commonly used medicines have adverse effects on cardiovascular health, particularly so in patients with heart failure. The mechanisms of these effects are varied, and, whereas some are common and predictable, others are less so. Prescrib...

Taking the reader from an understanding of the basic mechanisms of heart failure through to an appreciation of the complexities of heart failure management and the remarkable improvements possible with good treatment, the Oxford Textbook of Heart Failure 2e covers all aspects necessary to manage a patient with heart failure. The new edition has bee...

Background General practice in the UK is experiencing a crisis. Greater multidisciplinary working is a potential solution. The new general practice contract in Scotland encourages this and includes a new pharmacotherapy service to be delivered by General Practice Clinical Pharmacists (GPCPs). Consensus is lacking for the standards of practice for d...

Background: With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of modern outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of...

Background General practice in the UK is experiencing a crisis. Greater multidisciplinary working is a potential solution. The new general practice contract in Scotland encourages this and includes a new pharmacotherapy service to be delivered by General Practice Clinical Pharmacists (GPCPs). Consensus is lacking for the standards of practice for d...

Pharmacy has developed many novel patient-facing roles across the globe, typically delivered through the lens of pharmaceutical care. The macro-level implementation of such interventions is, however, fraught with difficulty. At an individual-level, psychological barriers of pharmacists and their ability to deliver autonomous complex clinical care a...

Background: Patients with left ventricular systolic dysfunction (LVSD) following myocardial infarction (MI) are at high risk of developing heart failure. The addition of neprilysin inhibition to renin angiotensin system (RAS) inhibition may result in greater attenuation of adverse LV remodeling due to increased levels of substrates for neprilysin w...

Objectives As the role of the general practice clinical pharmacist (GPCP) evolves, there has been a shift towards patient-facing roles across multiple conditions. This study aimed to measure the self-reported cardiology training needs of GPCPs. Methods An online survey was developed. Participants were shown a list of statements on cardiac conditio...

Aims In patients at high risk of heart failure following myocardial infarction (MI) as a result of residual left ventricular systolic dysfunction (LVSD), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan may result in a greater attenuation of adverse left ventricular (LV) remodelling than renin angiotensin aldosterone system inhibi...

Introduction In patients at high risk of heart failure (HF) following myocardial infarction (MI) as a result of residual left ventricular systolic dysfunction (LVSD), the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan may result in a greater attenuation of adverse LV remodeling than renin angiotensin aldosterone system inhibition al...

Objectives Left ventricular systolic dysfunction (LVSD) is common following myocardial infarction (MI). Pharmacological management of secondary prevention is known to be sub‐optimal. Integration of pharmacists into clinical teams improves prescribing and quantitative outcomes. Few data have been published on patient views of pharmacist input. We ai...

Objectives: In Scotland, post-registration hospital pharmacists typically undertake a vocational foundation training programme. Beyond this, there are no mandatory structures for ongoing professional training. To support progression to a more advanced level, competency frameworks are increasingly being used. This study aimed to measure the self-re...

As the UK's population ages and the prevalence of heart failure rises, practice nurses need to be aware of how they can contribute to management and treatment. Lynsey Moir explains the symptoms of heart failure and indicates opportunities for nurses to boost patient care Heart failure is a complex clinical syndrome with a prevalence of 1–2% in the...

Glasgow city has the highest cardiovascular disease (CVD) mortality rate in the UK. Patients with left ventricular systolic dysfunction after acute myocardial infarction represent a ‘high-risk’ cohort for adverse CVD outcomes. The optimisation of secondary prevention medication in this group is often suboptimal. Our aim was to improve the use and t...

Background: Uncontrolled blood pressure (BP) is a major contributor to cardiovascular disease–related morbidity and mortality. However, evidence regarding the rate and factors associated with uncontrolled BP in Iraq is scarce. The objectives of this study were a) to assess the magnitude of and factors associated with patient BP control and b) to in...

Background: Uncontrolled blood pressure (BP) is a major contributor to cardiovascular disease-related morbidity and mortality. However, evidence regarding the rate and factors associated with uncontrolled BP in Iraq is scarce. The objectives of this study were a) to assess the magnitude of and factors associated with patient BP control and b) to i...

Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary p...

Objectives Medication adherence is the end result of a complex set of interwoven factors. Non‐adherence with medication in heart failure patients is associated with excess mortality and morbidity. Studies describing interventions to improve adherence in heart failure are limited by a lack of robust methods and inconsistent outcomes. The aim of this...

Objectives Heart failure is an escalating ‘pandemic’ with malignant outcomes. Clinical pharmacist heart failure services have been developing for the past two decades. However, little clarity is available on the additional advanced knowledge, skills and experience needed for pharmacists to practice safely and competently. We aimed to provide an exp...

BACKGROUND: Heart failure (HF) appears under-represented in Scottish general practice disease registers compared with accepted prevalence figures. Scottish general practices are required to enter two codes to add patients to a register and also distinguish between HF with reduced ejection fraction (HF-REF) and HF with preserved ejection fraction (H...

Heart failure (HF) is a malignant condition with many presentations. The type of HF directs appropriate therapeutic management. Primary care is increasingly seen as a solution to improving the variation in outcomes seen in national HF audits. This article describes and summarises existing UK primary care HF services and emerging issues of importanc...

Background: Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF. Objective:...

The effect on mortality and morbidity of pharmacist-led intervention to optimize pharmacological therapy in patients with systolic heart failure (HF) has not been tested in a large-scale, long-term, clinical trial. We describe the rationale and design of a UK, primary care-based, prospective cluster-randomized controlled trial of a pharmacist-led i...