Pharmacists and their teams should consider the following points during a medicines use review:

• Use your PMR to review the history of the medicines prescribed and dose changes
• Ask the patient/carer how they have been getting on with the medicines when the doses were increased
• Establish if there is an agreed management plan with a heart failure nurse/pharmacist
• Assess patient adherence and if they have any concerns about their medicines
• Reconcile medicine after discharge and check that the patient is clear about all changes to their medicines and has no concerns
• Check for signs of dehydration and whether any increase in diuretic doses was temporary and not long term (especially augmented diuresis)
• Look out for medicines with high sodium content
• Check if the patient is using any over the counter herbal remedies or supplements and check if suitable for use in heart failure
• Give a reminder on lifestyle advice
• Make sure your signposting list includes information on local exercise programmes for people with heart failure (they may be provided as part of cardiac rehab)
• Watch out for worsening symptoms. NHS Clinical Knowledge Summaries advises that patients should “seek medical advice if they experience a rapid deterioration in symptoms, such as tiredness, fatigue, or breathlessness. Worsening symptoms can usually be controlled by adjusting other medications, and beta blockers should never be stopped without consulting a healthcare professional”.