Chloe Hava
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[post_content] => Aside from administering medicines by injection, Queensland-based community pharmacist Fiona Watson MPS loves tearing up a Latin dance floor.
Tell us about your pharmacy career.
I had a varied early career, moving to North Queensland for a year shortly after I graduated as well as locuming around Australia for a while.
This gave me a great introduction to community pharmacy and a lot of different experiences – both good and bad. When locuming, you develop a clear idea of the factors that contribute to a well-run pharmacy.
I then moved to the United Kingdom where I completed a Certificate in Clinical Pharmacy. You can tell how old I am because I was one of the last pharmacists able to register in the UK with only a month under supervision.
I was a ‘rotational resident pharmacist’, living on-site at the hospital. I covered renal, gastro, cardiology, oncology, aged care, palliative care and surgery wards.
We worked on call overnight, and could get called upon to help with all sorts of different situations – one of the most interesting being calculating the correct dose for the antidote to antifreeze.
More recently, I was very fortunate to be given the opportunity to go into partnership with my mum and sister, both pharmacists, as the managing partner at Redland Bay Wholelife Pharmacy and Healthfoods.
What medicines do you administer by injection?
About 10 years ago, I became a trained vaccinator administering thousands of vaccines during the COVID-19 pandemic.
When Queensland allowed pharmacists to expand the range of medicines they could administer, I completed the Medication Administration course, as I believe this is an essential skill for pharmacists to have.
So many new medications are injectable, and for some patients self-administration just isn’t an option. We were one of the first pharmacies in our area to offer long-acting injectable buprenorphine services, which can be a life-changing option for patients.
Tell us about your administering injections beyond vaccines.
The majority of pharmacists I work with at Redland Bay are trained vaccinators and have completed medicines administration courses. When we come across a new medication that requires administration by injection we collate the available information from the manufacturer and ensure everyone has read it. Many companies, such as Novartis with inclisiran (Leqvio), have reps who are happy to provide additional training.
Once you are comfortable with subcutaneous injections, it’s a matter of familiarising yourself with the different types of devices available. It seemed a logical step for us to provide this service. We have great consult room facilities and it brings variety to our role.
What role do you see pharmacists playing in cardiovascular care in future?
The sky is the limit. We’re on the cusp of a fundamental change in the way Australians receive health care and I hope to see pharmacists embrace the opportunities this will bring.
There’s a workforce crisis and an ageing population, so we need to become more efficient and accessible. If you think about how much the role of a nurse practitioner has changed in the last 10–15 years, you can see where pharmacists have even greater potential. A patient with a diagnosis of heart failure should be able to be titrated to optimum therapy by a pharmacist in a community pharmacy. A patient should have their HbA1c or lipids checked in the pharmacy, with appropriate therapy initiated or adjusted. We should also be actively involved in screening and chronic disease management.
Pharmacy is an incredibly rewarding and enjoyable career, and now is an especially exciting time to be a pharmacist. There is just so much opportunity.
Day in the life of Fiona Watson MPS, Community pharmacist at Redland Bay Wholelife Pharmacy, QLD.
| 5.00am |
Hit the gym I get up and do a HIIT or Muay Thai class most mornings for positive effects on my mental health. Passionate about preventative health care, I see the long-term effects of patients’ lifestyle choices every day. |
| 8.00am |
Open the pharmacy Every day is different. At least two pharmacists are rostered on, ensuring we give each patient the time they need while providing a wide range of different services. |
| 9.00am |
Vaccination service Embarking on a cruise in 2 months, a couple in their 60s asks about COVID-19 vaccines. More than 12 months since their last vaccine they are happy to be vaccinated on the spot. Not wanting more than one vaccine at a time, we book them in for a follow-up appointment in a month for the shingles vaccination. |
| 10.00am |
Collaborative care A local GP phones about a recently discharged mutual patient who’s not coping well on his new medicines. We spend some time with the patient doing a medicine review and setting up his profile for a dose administration aid. |
| 1.00pm |
Lunchtime It’s important that all staff, especially pharmacists, prioritise their breaks. We all need a little downtime to reset and refresh. |
| 1.30pm |
Medicines injection A regular patient comes in for her second dose of inclisiran (Leqvio) after I administered her first 3 months ago. She is happy with the more convenient option than visiting her GP. |
| 3.00pm |
Infection control In a call from our pharmacy car park, we learn a patient has tested positive for COVID-19 and has an e-script. We dispense and counsel over the phone and then deliver out to their car (with appropriate precautions). |
| 6.30pm |
OCP continuance A stressed young woman, with a 2-week wait for a GP appointment, has run out of her pill. She is relieved when seen by a colleague who prescribes Estelle under the Queensland Hormonal Contraceptive Pilot. I dispense it. |
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[post_content] => Vaccination coverage in older Australians remains alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
Older Australians are highly susceptible to serious complications from influenza and COVID-19. But the vaccination rates in patients aged 75 and over are nowhere where they need to be to protect this vulnerable patient cohort from harm, including hospitalisations and death.
The national influenza vaccination rate of patients aged 65 and over currently sits at 7.2%. And in the last 12 months, only 37.7% of Australians aged 75 and over received a COVID-19 vaccination.
But boosting immunisation rates in older Australians is more important than ever. The influenza season started earlier and stronger than usual, with 60,594 cases of influenza reported this year.
As of 10 April, there were also 70 active outbreaks of COVID-19 in residential aged care facilities (RACFs). Last year, case numbers were highest among those most at risk, with notifications peaking in the 75–79, 80–84 and 85+ (12,607).
With GPs not always available to address vaccination gaps in aged care, pharmacists are well positioned to step in and provide this essential service.
In the video above, community pharmacist Lachlan Rose MPS outlines the benefits of providing offsite vaccinations in aged care settings, including financial incentives, workplace variety and the protection of one of the most vulnerable populations.
[post_title] => All pharmacists should consider off-site vaccinations in aged care
[post_excerpt] => Vaccination rates in older Australians are alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
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[title] => All pharmacists should consider off-site vaccinations in aged care
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[post_content] => The Fair Work Commission’s Expert Panel for pay equity in the care and community sector has today issued its initial decision on the Gender-based undervaluation – priority awards review – making determinations on the Pharmacy Industry Award 2020, which most community pharmacists are employed under.
What did the Expert Panel find?
The Expert Panel found that pharmacists covered by the Pharmacy Industry Award 2020 (and several other awards) have been the subject of gender-based undervaluation.
As a result, the Expert Panel has determined that findings constitute work value reasons, justifying variation of the modern award minimum wage rates across all categories of pharmacists.
What is ‘gender-based undervaluation’?
Gender-based undervaluation considers a range of factors to determine whether minimum award pay rates are undervalued because of assumptions based on gender.
The range of factors considered extends to historical undervaluing, exercise of ‘invisible skills’, exercise of caring work and workforce qualifications, among others.
How does the Expert Panel intend to address the undervaluation?
For pharmacists employed by the Pharmacy Industry Award 2020, the Expert Panel has issued a determination that there will be a total increase in the minimum wage rates of 14.1% over three years.
This increase will be implemented in three equal phases on:
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[post_content] => Case scenario
Malcolm (68 years old, male) visits your pharmacy with a new prescription for sacubitril/valsartan. He mentions he has recently been diagnosed with heart failure with reduced ejection fraction (HFrEF). You review his records and confirm he is still taking metformin/sitagliptin for type 2 diabetes. Malcolm explains that he has taken this for many years, and that his general practitioner has advised him that his blood glucose control needs to be better. He expresses frustration that the shortness of breath from his heart failure limits his ability to exercise and improve his diabetes. Malcolm hopes that starting this new medicine will improve this.
After reading this article, pharmacists should be able to:
|
Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.
Heart failure is a clinical syndrome caused by the inability of the heart muscle to provide adequate cardiac output and/or the presence of increased cardiac pressure. This is due to either a structural or functional abnormality of the heart.1 The clinical syndrome consists of symptoms such as breathlessness and fatigue and may be accompanied by signs of fluid accumulation such as peripheral oedema, elevated jugular venous pressure and pulmonary crackles.1
In many cases, heart failure may be both preventable and treatable. Choice of treatment depends on the type of heart failure present, with management being primarily pharmacological.1
Pharmacists play an essential role in optimising pharmacotherapy for heart failure patients, providing recommendations on safe and effective dose titration and appropriate pharmacological management, as well as providing education, counselling and support for adherence.2
Heart failure remains a global public health issue that affects at least 38 million people worldwide.2 It is a major cause of hospitalisation in Australia and is associated with significant healthcare costs.3
Heart failure has a poor prognosis and results in markedly reduced quality of life.1 Readmission to hospital is extremely common, with about 1 in 3 patients being readmitted in the first month, and up to 15% of patients dying within the first 6 months, after being discharged from hospital.4 By 12 months post-discharge, approximately 25% of heart failure patients will have died.5
Concerningly, due to population aging and increasing prevalence of comorbidities, heart failure hospitalisations could increase by as much as 50% in the next 25 years.1
Categorisation of heart failureHeart failure is categorised according to the measurement of the left ventricular ejection fraction (LVEF). Knowing the LVEF at time of diagnosis is crucial, as this guides treatment.1 Heart failure is categorised as either1,6,7:
HFrEF
For HFrEF, there are effective pharmacological therapies, supported by robust, high-quality evidence. These include what has now become known as ‘the four pillars’, and these collectively make up guideline-directed medical therapy for HFrEF. These include9–11:
All patients with HFrEF should be prescribed all four agents (unless contraindicated or not tolerated), with early initiation being associated with the best outcomes.1,9,10 Other therapies are available as HFrEF progresses, however the ‘four pillars’ are the cornerstone of HFrEF treatment.10
HFmrEF
There is limited evidence to support specific recommendations for the pharmacological management of HFmrEF.1 Some studies suggest that patients with HFmrEF may receive similar benefit from a beta blocker, a mineralocorticoid receptor antagonist and a renin angiotensin system inhibitor as in HFrEF, and SGLT2is have been shown to reduce the risk of cardiovascular death and hospitalisation for heart failure.14 The medicines used to treat HFrEF are often used to treat HFmrEF, however the confidence in prognostic benefits is much less.1,14
HFpEF
For the treatment of HFpEF, no medicines have demonstrated a statistically significant benefit on mortality.1 Recommended treatment consists of15:
The use of an SGLT2i in HFpEF has not been shown to improve mortality to the same extent as for HFrEF. However, an SGLT2i is still recommended because major trials have shown they can still offer some benefits.16,17
The EMPEROR-Preserved trial demonstrated a 21% lower relative risk in the composite of cardiovascular death or hospitalisation for heart failure with the use of empagliflozin in the treatment of HFpEF compared with placebo – a result driven primarily by a reduction in risk of hospitalisation rather than mortality.16 Importantly, this benefit was seen regardless of the diabetic status of the patient.16 This benefit was later reinforced by the DELIVER trial which showed a lower risk of its composite primary outcome of worsening heart failure or cardiovascular death with dapagliflozin use, compared to placebo for those with HFmrEF and HFpEF.18 As a result, SGLT2is have received a strong recommendation for the management of HFpEF in treatment guidelines.1
Additionally, mineralocorticoid receptor antagonists are used in clinical practice because they have been associated with a reduction in risk of hospitalisation for HFpEF patients, as demonstrated by the TOPCAT trial.19
A focus on SGLT2isInitially developed as a medicine used for type 2 diabetes, SGLT2is have become a crucial cardiovascular drug class, as demonstrated above by their role in the management of heart failure, and now have renal and cardiovascular indications irrespective of type 2 diabetic status. This is largely due to results of cardiovascular outcome trials mandated by the United States Food and Drug Administration (FDA) in 2008. These trials led to findings that have significantly changed clinical practice.20 They arose from concerns of cardiovascular risks with certain medicines used for type 2 diabetes, evidence suggesting rosiglitazone may increase the risk of myocardial infarction, and in recognition of the high prevalence of cardiovascular disease in these patients.20
SGLT2is lower blood glucose by inhibiting SGLT2 transporters in the proximal tubules of the kidneys to decrease glucose reabsorption, which increases the excretion of glucose in the urine.21 Sodium excretion also occurs because the SGLT2 receptor is close to, and works together with, a sodium/hydrogen exchanger, which is a major receptor responsible for sodium reuptake.22
Although SGLT2is lower blood glucose, blood pressure and contribute to diuresis, their benefits in terms of renal and cardiovascular outcomes cannot be solely attributed to these properties, as similar clinical benefits are not seen with other agents that lower glucose, blood pressure or increase natriuresis to similar or greater extent.23,24 The mechanism of action linked to these benefits is complex, and appears to also be a combination of anti-inflammatory and anti-fibrotic effects, a reduction in epicardial fat and a reduction in hyperinsulinaemia.21
Additional evidence also suggests a reduction in oxidative stress, less coronary microvascular injury and improved contractile performance.23 Emerging clinical evidence may also suggest antiarrhythmic properties, which is particularly important given that ventricular arrhythmias and sudden cardiac death is a major cause of death in heart failure patients.21 Some trials have demonstrated a decrease in sudden cardiac death for patients using a SGLT2i.21
The EMPA-REG OUTCOME trial in 2015 was a landmark study, demonstrating that empagliflozin significantly reduced cardiovascular death among high-risk patients with type 2 diabetes, compared to placebo.25 Importantly, it also suggested renal benefits, with less cases of acute renal failure in the empagliflozin group.25 These findings were later confirmed by the EMPA-Kidney (empagliflozin) and DAPA-CKD (dapagliflozin) trials, which both showed reduced rates of death due to renal disease, slower decline in renal function and delayed time to needing dialysis.26–28
The cardiovascular benefits of these medicines went on to be confirmed in further trials including the DAPA-HF (2019), EMPEROR Reduced (2020), EMPEROR Preserved (2021) and DELIVER (2022) trials.16,18,29,30
Key practice points
Knowledge to practice The use of heart failure guideline-directed medical therapy in HFrEF can have a significant impact on patient outcomes. The combination of the ‘four pillars’ (a heart failure beta blocker, an mineralocorticoid receptor antagonist, a renin angiotensin system inhibitor and an SGLT2i) has the ability to improve life expectancy, delay disease progression, decrease heart failure symptoms and improve quality of life.9,10 All patients with HFrEF should be prescribed all four agents unless a contraindication or intolerance exists preventing their use.32
In HFpEF, there are currently no medicines that demonstrate a statistically significant benefit on mortality. However, the use of SGLT2is has been shown to reduce risk of hospitalisation (regardless of diabetic status) and are recommended to be used by guidelines as part of its management, and in the managment of HFmrEF.1,9,14
Heart failure remains a significant health burden, but modern medicines, particularly SGLT2is, can offer significant benefits. Pharmacists play a pivotal role in optimising therapy, ensuring adherence, and providing education to patients. By leveraging their expertise as medication experts, pharmacists can profoundly impact outcomes, improving survival and quality of life for individuals living with heart failure and associated comorbidities.
Case scenario continuedRecognising the benefits of an SGLT2i for both Malcolm’s heart failure and diabetes, you discuss the option of adding an SGLT2i to his regimen, and the potential benefits and risks. Malcolm explains that his main priority is to get his heart failure symptoms under control so that he can play with his grandchildren and exercise comfortably. At Malcolm’s request, you contact his GP, and it is agreed to commence empagliflozin 10 mg daily (after ensuring his eGFR is appropriate). This intervention may help to reduce Malcolm’s risk of death from heart failure, improve his quality of life, delay disease progression, improve diabetic control and assist in helping him achieve his health goals. |
[cpd_submit_answer_button]
Cassie Potts (she/her) BPharm, GradCertChronCondMgt, FANZCAP (Cardiol), AdPhaM is a Senior Clinical Pharmacist with SA Pharmacy and has over 11 years of experience specialising in heart failure as part of the cardiology team at Flinders Medical Centre. She serves on the AdPha Cardiology Leadership Committee and currently practises within the intensive care unit at the Royal Adelaide Hospital.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
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[post_content] => Data shows that while community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
Australia is experiencing its worst start to an influenza season, with case numbers surging and vaccination rates falling behind across key age groups.
Amid early peaks, a rise in influenza B cases, and sluggish immunisation uptake, Australian Pharmacist presents a visual snapshot of how the 2025 flu season is unfolding – and what must be done now to prevent a looming public health crisis.
1. Influenza case numbers have reached unprecedented levels to start 2025
This year, influenza cases have reached their highest level in almost a quarter of a century (24 years). To date, there have been 58,203 notifications of laboratory-confirmed influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) – with 2025 Quarter One case reports dwarfing that of previous years.
The flu season started earlier than usual this year, with cases surging sooner than in previous years. Early peaks often lead to higher overall case numbers – particularly when coupled with low immunisation rates.
In 2025, there has been a higher proportion of influenza B cases than in previous years, particularly in school-aged children and young adults, said Professor Anthony Lawler, Australian Government Chief Medical Officer. ‘Influenza B is often more common in children, and can result in more severe infections in children,’ he said.
[caption id="attachment_29144" align="aligncenter" width="500"]
Professor Anthony Lawler, Australian Government Chief Medical Officer, got his 2025 vaccine at a Canberra community pharmacy[/caption]
With the northern hemisphere experiencing a severe influenza season, and strains in this region typically migrating south, Rural Doctors Association of Victoria president Louise Manning said the trend was ‘worrying’.
‘We're quite concerned that, given the severity of symptoms and the number of hospitalisations in the northern hemisphere in their winter, that we'll have a similar picture here,’ Dr Manning told the ABC.
2. Pharmacists have had a fast start to influenza vaccination
Data over the last 4 years shows pharmacist-administered vaccines are experiencing continued growth.
Key factors influencing this growth include increased trust in the pharmacy profession to administer vaccines as well as accessibility. With longer operating hours – including evenings and weekends – pharmacies offer greater accessibility, allowing patients to receive influenza vaccinations without appointments or extended wait times. This convenience factor makes pharmacy a more flexible alternative to traditional healthcare settings such as General Practice.
3. Vaccination rates are far too low in children under 5
When it comes to influenza, children aged 0–5 are one of the most vulnerable cohorts – with the high risk of severe complications sometimes leading to hospitalisations, often due to pneumonia, and death.
Despite the risks, vaccination rates remain low in this age cohort, with only 7,398 children aged 0–5 receiving the influenza vaccine so far this year.
Despite the influenza vaccine being covered under the National Immunisation Program for this age group, less than half (45%) of parents are aware that their child can be vaccinated free of charge.
In 2024, only 25.8% of children 6 months to 4 years received an influenza vaccine – with three quarters of this at risk population remaining unvaccinated.
Many parents believe that influenza is not a serious disease or that the vaccine is ineffective or unsafe, with 29% exposed to misinformation and 26% influenced by anti-vaccine sentiment through social media.
Vaccine access can also prove challenging. To boost participation in young children, PSA maintains that there should be ‘no wrong door’ when it comes to vaccination – meaning pharmacists should be able to provide influenza vaccines alongside other childhood immunisations, said Chris Campbell MPS, PSA General Manager Policy and Program Delivery.
‘What [this] does do is increase the convenience for someone to be able to get the vaccine at a time and place of their choosing,’ he said.
‘There should be an increase in vaccine uptake in children under 5 years of age when there’s an opportunity for an entire family to come to the pharmacy and get vaccinated.’
4. Vaccination rates in all cohorts need to improve to stave off a devastating influenza season
The latest data on influenza vaccination coverage in Australia for 2025 reveals concerningly low uptake across all age groups and jurisdictions. Western Australia, Tasmania, and Victoria report particularly low figures at this stage among children 6 months to >5 years and aged 5 to under 15 years, with some states showing uptake as low as 0.1%.
Among patients aged 50 to under 65 years, national coverage sits at 2.8%, with Queensland (4.5%) and South Australia (4.0%) leading the charge. Coverage increases more significantly in the over 65s demographic – with South Australia (14.2%) and Queensland (12.6%) again topping vaccination coverage.
Vaccine manufacturers are also expecting a surge in cases, with CSLSeqirus revealing it has boosted its vaccine output by 100,000 doses this season.
To protect the community from a particularly nasty influenza season, experts have urged people to roll up their sleeves and get vaccinated.
‘If you don't want to get crook get vaccinated,’ Public Health Association of Australia chief executive Terry Slevin said.
‘You're less likely to get crook and if you do get crook, you'll be crook for a shorter period of time ... and reduce the misery.’
[post_title] => Flu cases surge to record highs as vaccination rates stall
[post_excerpt] => While community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
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[post_content] => Aside from administering medicines by injection, Queensland-based community pharmacist Fiona Watson MPS loves tearing up a Latin dance floor.
Tell us about your pharmacy career.
I had a varied early career, moving to North Queensland for a year shortly after I graduated as well as locuming around Australia for a while.
This gave me a great introduction to community pharmacy and a lot of different experiences – both good and bad. When locuming, you develop a clear idea of the factors that contribute to a well-run pharmacy.
I then moved to the United Kingdom where I completed a Certificate in Clinical Pharmacy. You can tell how old I am because I was one of the last pharmacists able to register in the UK with only a month under supervision.
I was a ‘rotational resident pharmacist’, living on-site at the hospital. I covered renal, gastro, cardiology, oncology, aged care, palliative care and surgery wards.
We worked on call overnight, and could get called upon to help with all sorts of different situations – one of the most interesting being calculating the correct dose for the antidote to antifreeze.
More recently, I was very fortunate to be given the opportunity to go into partnership with my mum and sister, both pharmacists, as the managing partner at Redland Bay Wholelife Pharmacy and Healthfoods.
What medicines do you administer by injection?
About 10 years ago, I became a trained vaccinator administering thousands of vaccines during the COVID-19 pandemic.
When Queensland allowed pharmacists to expand the range of medicines they could administer, I completed the Medication Administration course, as I believe this is an essential skill for pharmacists to have.
So many new medications are injectable, and for some patients self-administration just isn’t an option. We were one of the first pharmacies in our area to offer long-acting injectable buprenorphine services, which can be a life-changing option for patients.
Tell us about your administering injections beyond vaccines.
The majority of pharmacists I work with at Redland Bay are trained vaccinators and have completed medicines administration courses. When we come across a new medication that requires administration by injection we collate the available information from the manufacturer and ensure everyone has read it. Many companies, such as Novartis with inclisiran (Leqvio), have reps who are happy to provide additional training.
Once you are comfortable with subcutaneous injections, it’s a matter of familiarising yourself with the different types of devices available. It seemed a logical step for us to provide this service. We have great consult room facilities and it brings variety to our role.
What role do you see pharmacists playing in cardiovascular care in future?
The sky is the limit. We’re on the cusp of a fundamental change in the way Australians receive health care and I hope to see pharmacists embrace the opportunities this will bring.
There’s a workforce crisis and an ageing population, so we need to become more efficient and accessible. If you think about how much the role of a nurse practitioner has changed in the last 10–15 years, you can see where pharmacists have even greater potential. A patient with a diagnosis of heart failure should be able to be titrated to optimum therapy by a pharmacist in a community pharmacy. A patient should have their HbA1c or lipids checked in the pharmacy, with appropriate therapy initiated or adjusted. We should also be actively involved in screening and chronic disease management.
Pharmacy is an incredibly rewarding and enjoyable career, and now is an especially exciting time to be a pharmacist. There is just so much opportunity.
Day in the life of Fiona Watson MPS, Community pharmacist at Redland Bay Wholelife Pharmacy, QLD.
| 5.00am |
Hit the gym I get up and do a HIIT or Muay Thai class most mornings for positive effects on my mental health. Passionate about preventative health care, I see the long-term effects of patients’ lifestyle choices every day. |
| 8.00am |
Open the pharmacy Every day is different. At least two pharmacists are rostered on, ensuring we give each patient the time they need while providing a wide range of different services. |
| 9.00am |
Vaccination service Embarking on a cruise in 2 months, a couple in their 60s asks about COVID-19 vaccines. More than 12 months since their last vaccine they are happy to be vaccinated on the spot. Not wanting more than one vaccine at a time, we book them in for a follow-up appointment in a month for the shingles vaccination. |
| 10.00am |
Collaborative care A local GP phones about a recently discharged mutual patient who’s not coping well on his new medicines. We spend some time with the patient doing a medicine review and setting up his profile for a dose administration aid. |
| 1.00pm |
Lunchtime It’s important that all staff, especially pharmacists, prioritise their breaks. We all need a little downtime to reset and refresh. |
| 1.30pm |
Medicines injection A regular patient comes in for her second dose of inclisiran (Leqvio) after I administered her first 3 months ago. She is happy with the more convenient option than visiting her GP. |
| 3.00pm |
Infection control In a call from our pharmacy car park, we learn a patient has tested positive for COVID-19 and has an e-script. We dispense and counsel over the phone and then deliver out to their car (with appropriate precautions). |
| 6.30pm |
OCP continuance A stressed young woman, with a 2-week wait for a GP appointment, has run out of her pill. She is relieved when seen by a colleague who prescribes Estelle under the Queensland Hormonal Contraceptive Pilot. I dispense it. |
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[post_content] => Vaccination coverage in older Australians remains alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
Older Australians are highly susceptible to serious complications from influenza and COVID-19. But the vaccination rates in patients aged 75 and over are nowhere where they need to be to protect this vulnerable patient cohort from harm, including hospitalisations and death.
The national influenza vaccination rate of patients aged 65 and over currently sits at 7.2%. And in the last 12 months, only 37.7% of Australians aged 75 and over received a COVID-19 vaccination.
But boosting immunisation rates in older Australians is more important than ever. The influenza season started earlier and stronger than usual, with 60,594 cases of influenza reported this year.
As of 10 April, there were also 70 active outbreaks of COVID-19 in residential aged care facilities (RACFs). Last year, case numbers were highest among those most at risk, with notifications peaking in the 75–79, 80–84 and 85+ (12,607).
With GPs not always available to address vaccination gaps in aged care, pharmacists are well positioned to step in and provide this essential service.
In the video above, community pharmacist Lachlan Rose MPS outlines the benefits of providing offsite vaccinations in aged care settings, including financial incentives, workplace variety and the protection of one of the most vulnerable populations.
[post_title] => All pharmacists should consider off-site vaccinations in aged care
[post_excerpt] => Vaccination rates in older Australians are alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
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[title] => All pharmacists should consider off-site vaccinations in aged care
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[post_content] => The Fair Work Commission’s Expert Panel for pay equity in the care and community sector has today issued its initial decision on the Gender-based undervaluation – priority awards review – making determinations on the Pharmacy Industry Award 2020, which most community pharmacists are employed under.
What did the Expert Panel find?
The Expert Panel found that pharmacists covered by the Pharmacy Industry Award 2020 (and several other awards) have been the subject of gender-based undervaluation.
As a result, the Expert Panel has determined that findings constitute work value reasons, justifying variation of the modern award minimum wage rates across all categories of pharmacists.
What is ‘gender-based undervaluation’?
Gender-based undervaluation considers a range of factors to determine whether minimum award pay rates are undervalued because of assumptions based on gender.
The range of factors considered extends to historical undervaluing, exercise of ‘invisible skills’, exercise of caring work and workforce qualifications, among others.
How does the Expert Panel intend to address the undervaluation?
For pharmacists employed by the Pharmacy Industry Award 2020, the Expert Panel has issued a determination that there will be a total increase in the minimum wage rates of 14.1% over three years.
This increase will be implemented in three equal phases on:
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[post_content] => Case scenario
Malcolm (68 years old, male) visits your pharmacy with a new prescription for sacubitril/valsartan. He mentions he has recently been diagnosed with heart failure with reduced ejection fraction (HFrEF). You review his records and confirm he is still taking metformin/sitagliptin for type 2 diabetes. Malcolm explains that he has taken this for many years, and that his general practitioner has advised him that his blood glucose control needs to be better. He expresses frustration that the shortness of breath from his heart failure limits his ability to exercise and improve his diabetes. Malcolm hopes that starting this new medicine will improve this.
After reading this article, pharmacists should be able to:
|
Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.
Heart failure is a clinical syndrome caused by the inability of the heart muscle to provide adequate cardiac output and/or the presence of increased cardiac pressure. This is due to either a structural or functional abnormality of the heart.1 The clinical syndrome consists of symptoms such as breathlessness and fatigue and may be accompanied by signs of fluid accumulation such as peripheral oedema, elevated jugular venous pressure and pulmonary crackles.1
In many cases, heart failure may be both preventable and treatable. Choice of treatment depends on the type of heart failure present, with management being primarily pharmacological.1
Pharmacists play an essential role in optimising pharmacotherapy for heart failure patients, providing recommendations on safe and effective dose titration and appropriate pharmacological management, as well as providing education, counselling and support for adherence.2
Heart failure remains a global public health issue that affects at least 38 million people worldwide.2 It is a major cause of hospitalisation in Australia and is associated with significant healthcare costs.3
Heart failure has a poor prognosis and results in markedly reduced quality of life.1 Readmission to hospital is extremely common, with about 1 in 3 patients being readmitted in the first month, and up to 15% of patients dying within the first 6 months, after being discharged from hospital.4 By 12 months post-discharge, approximately 25% of heart failure patients will have died.5
Concerningly, due to population aging and increasing prevalence of comorbidities, heart failure hospitalisations could increase by as much as 50% in the next 25 years.1
Categorisation of heart failureHeart failure is categorised according to the measurement of the left ventricular ejection fraction (LVEF). Knowing the LVEF at time of diagnosis is crucial, as this guides treatment.1 Heart failure is categorised as either1,6,7:
HFrEF
For HFrEF, there are effective pharmacological therapies, supported by robust, high-quality evidence. These include what has now become known as ‘the four pillars’, and these collectively make up guideline-directed medical therapy for HFrEF. These include9–11:
All patients with HFrEF should be prescribed all four agents (unless contraindicated or not tolerated), with early initiation being associated with the best outcomes.1,9,10 Other therapies are available as HFrEF progresses, however the ‘four pillars’ are the cornerstone of HFrEF treatment.10
HFmrEF
There is limited evidence to support specific recommendations for the pharmacological management of HFmrEF.1 Some studies suggest that patients with HFmrEF may receive similar benefit from a beta blocker, a mineralocorticoid receptor antagonist and a renin angiotensin system inhibitor as in HFrEF, and SGLT2is have been shown to reduce the risk of cardiovascular death and hospitalisation for heart failure.14 The medicines used to treat HFrEF are often used to treat HFmrEF, however the confidence in prognostic benefits is much less.1,14
HFpEF
For the treatment of HFpEF, no medicines have demonstrated a statistically significant benefit on mortality.1 Recommended treatment consists of15:
The use of an SGLT2i in HFpEF has not been shown to improve mortality to the same extent as for HFrEF. However, an SGLT2i is still recommended because major trials have shown they can still offer some benefits.16,17
The EMPEROR-Preserved trial demonstrated a 21% lower relative risk in the composite of cardiovascular death or hospitalisation for heart failure with the use of empagliflozin in the treatment of HFpEF compared with placebo – a result driven primarily by a reduction in risk of hospitalisation rather than mortality.16 Importantly, this benefit was seen regardless of the diabetic status of the patient.16 This benefit was later reinforced by the DELIVER trial which showed a lower risk of its composite primary outcome of worsening heart failure or cardiovascular death with dapagliflozin use, compared to placebo for those with HFmrEF and HFpEF.18 As a result, SGLT2is have received a strong recommendation for the management of HFpEF in treatment guidelines.1
Additionally, mineralocorticoid receptor antagonists are used in clinical practice because they have been associated with a reduction in risk of hospitalisation for HFpEF patients, as demonstrated by the TOPCAT trial.19
A focus on SGLT2isInitially developed as a medicine used for type 2 diabetes, SGLT2is have become a crucial cardiovascular drug class, as demonstrated above by their role in the management of heart failure, and now have renal and cardiovascular indications irrespective of type 2 diabetic status. This is largely due to results of cardiovascular outcome trials mandated by the United States Food and Drug Administration (FDA) in 2008. These trials led to findings that have significantly changed clinical practice.20 They arose from concerns of cardiovascular risks with certain medicines used for type 2 diabetes, evidence suggesting rosiglitazone may increase the risk of myocardial infarction, and in recognition of the high prevalence of cardiovascular disease in these patients.20
SGLT2is lower blood glucose by inhibiting SGLT2 transporters in the proximal tubules of the kidneys to decrease glucose reabsorption, which increases the excretion of glucose in the urine.21 Sodium excretion also occurs because the SGLT2 receptor is close to, and works together with, a sodium/hydrogen exchanger, which is a major receptor responsible for sodium reuptake.22
Although SGLT2is lower blood glucose, blood pressure and contribute to diuresis, their benefits in terms of renal and cardiovascular outcomes cannot be solely attributed to these properties, as similar clinical benefits are not seen with other agents that lower glucose, blood pressure or increase natriuresis to similar or greater extent.23,24 The mechanism of action linked to these benefits is complex, and appears to also be a combination of anti-inflammatory and anti-fibrotic effects, a reduction in epicardial fat and a reduction in hyperinsulinaemia.21
Additional evidence also suggests a reduction in oxidative stress, less coronary microvascular injury and improved contractile performance.23 Emerging clinical evidence may also suggest antiarrhythmic properties, which is particularly important given that ventricular arrhythmias and sudden cardiac death is a major cause of death in heart failure patients.21 Some trials have demonstrated a decrease in sudden cardiac death for patients using a SGLT2i.21
The EMPA-REG OUTCOME trial in 2015 was a landmark study, demonstrating that empagliflozin significantly reduced cardiovascular death among high-risk patients with type 2 diabetes, compared to placebo.25 Importantly, it also suggested renal benefits, with less cases of acute renal failure in the empagliflozin group.25 These findings were later confirmed by the EMPA-Kidney (empagliflozin) and DAPA-CKD (dapagliflozin) trials, which both showed reduced rates of death due to renal disease, slower decline in renal function and delayed time to needing dialysis.26–28
The cardiovascular benefits of these medicines went on to be confirmed in further trials including the DAPA-HF (2019), EMPEROR Reduced (2020), EMPEROR Preserved (2021) and DELIVER (2022) trials.16,18,29,30
Key practice points
Knowledge to practice The use of heart failure guideline-directed medical therapy in HFrEF can have a significant impact on patient outcomes. The combination of the ‘four pillars’ (a heart failure beta blocker, an mineralocorticoid receptor antagonist, a renin angiotensin system inhibitor and an SGLT2i) has the ability to improve life expectancy, delay disease progression, decrease heart failure symptoms and improve quality of life.9,10 All patients with HFrEF should be prescribed all four agents unless a contraindication or intolerance exists preventing their use.32
In HFpEF, there are currently no medicines that demonstrate a statistically significant benefit on mortality. However, the use of SGLT2is has been shown to reduce risk of hospitalisation (regardless of diabetic status) and are recommended to be used by guidelines as part of its management, and in the managment of HFmrEF.1,9,14
Heart failure remains a significant health burden, but modern medicines, particularly SGLT2is, can offer significant benefits. Pharmacists play a pivotal role in optimising therapy, ensuring adherence, and providing education to patients. By leveraging their expertise as medication experts, pharmacists can profoundly impact outcomes, improving survival and quality of life for individuals living with heart failure and associated comorbidities.
Case scenario continuedRecognising the benefits of an SGLT2i for both Malcolm’s heart failure and diabetes, you discuss the option of adding an SGLT2i to his regimen, and the potential benefits and risks. Malcolm explains that his main priority is to get his heart failure symptoms under control so that he can play with his grandchildren and exercise comfortably. At Malcolm’s request, you contact his GP, and it is agreed to commence empagliflozin 10 mg daily (after ensuring his eGFR is appropriate). This intervention may help to reduce Malcolm’s risk of death from heart failure, improve his quality of life, delay disease progression, improve diabetic control and assist in helping him achieve his health goals. |
[cpd_submit_answer_button]
Cassie Potts (she/her) BPharm, GradCertChronCondMgt, FANZCAP (Cardiol), AdPhaM is a Senior Clinical Pharmacist with SA Pharmacy and has over 11 years of experience specialising in heart failure as part of the cardiology team at Flinders Medical Centre. She serves on the AdPha Cardiology Leadership Committee and currently practises within the intensive care unit at the Royal Adelaide Hospital.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
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[post_content] => Data shows that while community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
Australia is experiencing its worst start to an influenza season, with case numbers surging and vaccination rates falling behind across key age groups.
Amid early peaks, a rise in influenza B cases, and sluggish immunisation uptake, Australian Pharmacist presents a visual snapshot of how the 2025 flu season is unfolding – and what must be done now to prevent a looming public health crisis.
1. Influenza case numbers have reached unprecedented levels to start 2025
This year, influenza cases have reached their highest level in almost a quarter of a century (24 years). To date, there have been 58,203 notifications of laboratory-confirmed influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) – with 2025 Quarter One case reports dwarfing that of previous years.
The flu season started earlier than usual this year, with cases surging sooner than in previous years. Early peaks often lead to higher overall case numbers – particularly when coupled with low immunisation rates.
In 2025, there has been a higher proportion of influenza B cases than in previous years, particularly in school-aged children and young adults, said Professor Anthony Lawler, Australian Government Chief Medical Officer. ‘Influenza B is often more common in children, and can result in more severe infections in children,’ he said.
[caption id="attachment_29144" align="aligncenter" width="500"] Professor Anthony Lawler, Australian Government Chief Medical Officer, got his 2025 vaccine at a Canberra community pharmacy[/caption]
With the northern hemisphere experiencing a severe influenza season, and strains in this region typically migrating south, Rural Doctors Association of Victoria president Louise Manning said the trend was ‘worrying’.
‘We're quite concerned that, given the severity of symptoms and the number of hospitalisations in the northern hemisphere in their winter, that we'll have a similar picture here,’ Dr Manning told the ABC.
2. Pharmacists have had a fast start to influenza vaccination
Data over the last 4 years shows pharmacist-administered vaccines are experiencing continued growth.
Key factors influencing this growth include increased trust in the pharmacy profession to administer vaccines as well as accessibility. With longer operating hours – including evenings and weekends – pharmacies offer greater accessibility, allowing patients to receive influenza vaccinations without appointments or extended wait times. This convenience factor makes pharmacy a more flexible alternative to traditional healthcare settings such as General Practice.
3. Vaccination rates are far too low in children under 5
When it comes to influenza, children aged 0–5 are one of the most vulnerable cohorts – with the high risk of severe complications sometimes leading to hospitalisations, often due to pneumonia, and death.
Despite the risks, vaccination rates remain low in this age cohort, with only 7,398 children aged 0–5 receiving the influenza vaccine so far this year.
Despite the influenza vaccine being covered under the National Immunisation Program for this age group, less than half (45%) of parents are aware that their child can be vaccinated free of charge.
In 2024, only 25.8% of children 6 months to 4 years received an influenza vaccine – with three quarters of this at risk population remaining unvaccinated.
Many parents believe that influenza is not a serious disease or that the vaccine is ineffective or unsafe, with 29% exposed to misinformation and 26% influenced by anti-vaccine sentiment through social media.
Vaccine access can also prove challenging. To boost participation in young children, PSA maintains that there should be ‘no wrong door’ when it comes to vaccination – meaning pharmacists should be able to provide influenza vaccines alongside other childhood immunisations, said Chris Campbell MPS, PSA General Manager Policy and Program Delivery.
‘What [this] does do is increase the convenience for someone to be able to get the vaccine at a time and place of their choosing,’ he said.
‘There should be an increase in vaccine uptake in children under 5 years of age when there’s an opportunity for an entire family to come to the pharmacy and get vaccinated.’
4. Vaccination rates in all cohorts need to improve to stave off a devastating influenza season
The latest data on influenza vaccination coverage in Australia for 2025 reveals concerningly low uptake across all age groups and jurisdictions. Western Australia, Tasmania, and Victoria report particularly low figures at this stage among children 6 months to >5 years and aged 5 to under 15 years, with some states showing uptake as low as 0.1%.
Among patients aged 50 to under 65 years, national coverage sits at 2.8%, with Queensland (4.5%) and South Australia (4.0%) leading the charge. Coverage increases more significantly in the over 65s demographic – with South Australia (14.2%) and Queensland (12.6%) again topping vaccination coverage.
Vaccine manufacturers are also expecting a surge in cases, with CSLSeqirus revealing it has boosted its vaccine output by 100,000 doses this season.
To protect the community from a particularly nasty influenza season, experts have urged people to roll up their sleeves and get vaccinated.
‘If you don't want to get crook get vaccinated,’ Public Health Association of Australia chief executive Terry Slevin said.
‘You're less likely to get crook and if you do get crook, you'll be crook for a shorter period of time ... and reduce the misery.’
[post_title] => Flu cases surge to record highs as vaccination rates stall
[post_excerpt] => While community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
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[post_content] => Aside from administering medicines by injection, Queensland-based community pharmacist Fiona Watson MPS loves tearing up a Latin dance floor.
Tell us about your pharmacy career.
I had a varied early career, moving to North Queensland for a year shortly after I graduated as well as locuming around Australia for a while.
This gave me a great introduction to community pharmacy and a lot of different experiences – both good and bad. When locuming, you develop a clear idea of the factors that contribute to a well-run pharmacy.
I then moved to the United Kingdom where I completed a Certificate in Clinical Pharmacy. You can tell how old I am because I was one of the last pharmacists able to register in the UK with only a month under supervision.
I was a ‘rotational resident pharmacist’, living on-site at the hospital. I covered renal, gastro, cardiology, oncology, aged care, palliative care and surgery wards.
We worked on call overnight, and could get called upon to help with all sorts of different situations – one of the most interesting being calculating the correct dose for the antidote to antifreeze.
More recently, I was very fortunate to be given the opportunity to go into partnership with my mum and sister, both pharmacists, as the managing partner at Redland Bay Wholelife Pharmacy and Healthfoods.
What medicines do you administer by injection?
About 10 years ago, I became a trained vaccinator administering thousands of vaccines during the COVID-19 pandemic.
When Queensland allowed pharmacists to expand the range of medicines they could administer, I completed the Medication Administration course, as I believe this is an essential skill for pharmacists to have.
So many new medications are injectable, and for some patients self-administration just isn’t an option. We were one of the first pharmacies in our area to offer long-acting injectable buprenorphine services, which can be a life-changing option for patients.
Tell us about your administering injections beyond vaccines.
The majority of pharmacists I work with at Redland Bay are trained vaccinators and have completed medicines administration courses. When we come across a new medication that requires administration by injection we collate the available information from the manufacturer and ensure everyone has read it. Many companies, such as Novartis with inclisiran (Leqvio), have reps who are happy to provide additional training.
Once you are comfortable with subcutaneous injections, it’s a matter of familiarising yourself with the different types of devices available. It seemed a logical step for us to provide this service. We have great consult room facilities and it brings variety to our role.
What role do you see pharmacists playing in cardiovascular care in future?
The sky is the limit. We’re on the cusp of a fundamental change in the way Australians receive health care and I hope to see pharmacists embrace the opportunities this will bring.
There’s a workforce crisis and an ageing population, so we need to become more efficient and accessible. If you think about how much the role of a nurse practitioner has changed in the last 10–15 years, you can see where pharmacists have even greater potential. A patient with a diagnosis of heart failure should be able to be titrated to optimum therapy by a pharmacist in a community pharmacy. A patient should have their HbA1c or lipids checked in the pharmacy, with appropriate therapy initiated or adjusted. We should also be actively involved in screening and chronic disease management.
Pharmacy is an incredibly rewarding and enjoyable career, and now is an especially exciting time to be a pharmacist. There is just so much opportunity.
Day in the life of Fiona Watson MPS, Community pharmacist at Redland Bay Wholelife Pharmacy, QLD.
| 5.00am |
Hit the gym I get up and do a HIIT or Muay Thai class most mornings for positive effects on my mental health. Passionate about preventative health care, I see the long-term effects of patients’ lifestyle choices every day. |
| 8.00am |
Open the pharmacy Every day is different. At least two pharmacists are rostered on, ensuring we give each patient the time they need while providing a wide range of different services. |
| 9.00am |
Vaccination service Embarking on a cruise in 2 months, a couple in their 60s asks about COVID-19 vaccines. More than 12 months since their last vaccine they are happy to be vaccinated on the spot. Not wanting more than one vaccine at a time, we book them in for a follow-up appointment in a month for the shingles vaccination. |
| 10.00am |
Collaborative care A local GP phones about a recently discharged mutual patient who’s not coping well on his new medicines. We spend some time with the patient doing a medicine review and setting up his profile for a dose administration aid. |
| 1.00pm |
Lunchtime It’s important that all staff, especially pharmacists, prioritise their breaks. We all need a little downtime to reset and refresh. |
| 1.30pm |
Medicines injection A regular patient comes in for her second dose of inclisiran (Leqvio) after I administered her first 3 months ago. She is happy with the more convenient option than visiting her GP. |
| 3.00pm |
Infection control In a call from our pharmacy car park, we learn a patient has tested positive for COVID-19 and has an e-script. We dispense and counsel over the phone and then deliver out to their car (with appropriate precautions). |
| 6.30pm |
OCP continuance A stressed young woman, with a 2-week wait for a GP appointment, has run out of her pill. She is relieved when seen by a colleague who prescribes Estelle under the Queensland Hormonal Contraceptive Pilot. I dispense it. |
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[post_content] => Vaccination coverage in older Australians remains alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
Older Australians are highly susceptible to serious complications from influenza and COVID-19. But the vaccination rates in patients aged 75 and over are nowhere where they need to be to protect this vulnerable patient cohort from harm, including hospitalisations and death.
The national influenza vaccination rate of patients aged 65 and over currently sits at 7.2%. And in the last 12 months, only 37.7% of Australians aged 75 and over received a COVID-19 vaccination.
But boosting immunisation rates in older Australians is more important than ever. The influenza season started earlier and stronger than usual, with 60,594 cases of influenza reported this year.
As of 10 April, there were also 70 active outbreaks of COVID-19 in residential aged care facilities (RACFs). Last year, case numbers were highest among those most at risk, with notifications peaking in the 75–79, 80–84 and 85+ (12,607).
With GPs not always available to address vaccination gaps in aged care, pharmacists are well positioned to step in and provide this essential service.
In the video above, community pharmacist Lachlan Rose MPS outlines the benefits of providing offsite vaccinations in aged care settings, including financial incentives, workplace variety and the protection of one of the most vulnerable populations.
[post_title] => All pharmacists should consider off-site vaccinations in aged care
[post_excerpt] => Vaccination rates in older Australians are alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
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[post_date] => 2025-04-16 15:41:17
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[post_content] => The Fair Work Commission’s Expert Panel for pay equity in the care and community sector has today issued its initial decision on the Gender-based undervaluation – priority awards review – making determinations on the Pharmacy Industry Award 2020, which most community pharmacists are employed under.
What did the Expert Panel find?
The Expert Panel found that pharmacists covered by the Pharmacy Industry Award 2020 (and several other awards) have been the subject of gender-based undervaluation.
As a result, the Expert Panel has determined that findings constitute work value reasons, justifying variation of the modern award minimum wage rates across all categories of pharmacists.
What is ‘gender-based undervaluation’?
Gender-based undervaluation considers a range of factors to determine whether minimum award pay rates are undervalued because of assumptions based on gender.
The range of factors considered extends to historical undervaluing, exercise of ‘invisible skills’, exercise of caring work and workforce qualifications, among others.
How does the Expert Panel intend to address the undervaluation?
For pharmacists employed by the Pharmacy Industry Award 2020, the Expert Panel has issued a determination that there will be a total increase in the minimum wage rates of 14.1% over three years.
This increase will be implemented in three equal phases on:
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[post_content] => Case scenario
Malcolm (68 years old, male) visits your pharmacy with a new prescription for sacubitril/valsartan. He mentions he has recently been diagnosed with heart failure with reduced ejection fraction (HFrEF). You review his records and confirm he is still taking metformin/sitagliptin for type 2 diabetes. Malcolm explains that he has taken this for many years, and that his general practitioner has advised him that his blood glucose control needs to be better. He expresses frustration that the shortness of breath from his heart failure limits his ability to exercise and improve his diabetes. Malcolm hopes that starting this new medicine will improve this.
After reading this article, pharmacists should be able to:
|
Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.
Heart failure is a clinical syndrome caused by the inability of the heart muscle to provide adequate cardiac output and/or the presence of increased cardiac pressure. This is due to either a structural or functional abnormality of the heart.1 The clinical syndrome consists of symptoms such as breathlessness and fatigue and may be accompanied by signs of fluid accumulation such as peripheral oedema, elevated jugular venous pressure and pulmonary crackles.1
In many cases, heart failure may be both preventable and treatable. Choice of treatment depends on the type of heart failure present, with management being primarily pharmacological.1
Pharmacists play an essential role in optimising pharmacotherapy for heart failure patients, providing recommendations on safe and effective dose titration and appropriate pharmacological management, as well as providing education, counselling and support for adherence.2
Heart failure remains a global public health issue that affects at least 38 million people worldwide.2 It is a major cause of hospitalisation in Australia and is associated with significant healthcare costs.3
Heart failure has a poor prognosis and results in markedly reduced quality of life.1 Readmission to hospital is extremely common, with about 1 in 3 patients being readmitted in the first month, and up to 15% of patients dying within the first 6 months, after being discharged from hospital.4 By 12 months post-discharge, approximately 25% of heart failure patients will have died.5
Concerningly, due to population aging and increasing prevalence of comorbidities, heart failure hospitalisations could increase by as much as 50% in the next 25 years.1
Categorisation of heart failureHeart failure is categorised according to the measurement of the left ventricular ejection fraction (LVEF). Knowing the LVEF at time of diagnosis is crucial, as this guides treatment.1 Heart failure is categorised as either1,6,7:
HFrEF
For HFrEF, there are effective pharmacological therapies, supported by robust, high-quality evidence. These include what has now become known as ‘the four pillars’, and these collectively make up guideline-directed medical therapy for HFrEF. These include9–11:
All patients with HFrEF should be prescribed all four agents (unless contraindicated or not tolerated), with early initiation being associated with the best outcomes.1,9,10 Other therapies are available as HFrEF progresses, however the ‘four pillars’ are the cornerstone of HFrEF treatment.10
HFmrEF
There is limited evidence to support specific recommendations for the pharmacological management of HFmrEF.1 Some studies suggest that patients with HFmrEF may receive similar benefit from a beta blocker, a mineralocorticoid receptor antagonist and a renin angiotensin system inhibitor as in HFrEF, and SGLT2is have been shown to reduce the risk of cardiovascular death and hospitalisation for heart failure.14 The medicines used to treat HFrEF are often used to treat HFmrEF, however the confidence in prognostic benefits is much less.1,14
HFpEF
For the treatment of HFpEF, no medicines have demonstrated a statistically significant benefit on mortality.1 Recommended treatment consists of15:
The use of an SGLT2i in HFpEF has not been shown to improve mortality to the same extent as for HFrEF. However, an SGLT2i is still recommended because major trials have shown they can still offer some benefits.16,17
The EMPEROR-Preserved trial demonstrated a 21% lower relative risk in the composite of cardiovascular death or hospitalisation for heart failure with the use of empagliflozin in the treatment of HFpEF compared with placebo – a result driven primarily by a reduction in risk of hospitalisation rather than mortality.16 Importantly, this benefit was seen regardless of the diabetic status of the patient.16 This benefit was later reinforced by the DELIVER trial which showed a lower risk of its composite primary outcome of worsening heart failure or cardiovascular death with dapagliflozin use, compared to placebo for those with HFmrEF and HFpEF.18 As a result, SGLT2is have received a strong recommendation for the management of HFpEF in treatment guidelines.1
Additionally, mineralocorticoid receptor antagonists are used in clinical practice because they have been associated with a reduction in risk of hospitalisation for HFpEF patients, as demonstrated by the TOPCAT trial.19
A focus on SGLT2isInitially developed as a medicine used for type 2 diabetes, SGLT2is have become a crucial cardiovascular drug class, as demonstrated above by their role in the management of heart failure, and now have renal and cardiovascular indications irrespective of type 2 diabetic status. This is largely due to results of cardiovascular outcome trials mandated by the United States Food and Drug Administration (FDA) in 2008. These trials led to findings that have significantly changed clinical practice.20 They arose from concerns of cardiovascular risks with certain medicines used for type 2 diabetes, evidence suggesting rosiglitazone may increase the risk of myocardial infarction, and in recognition of the high prevalence of cardiovascular disease in these patients.20
SGLT2is lower blood glucose by inhibiting SGLT2 transporters in the proximal tubules of the kidneys to decrease glucose reabsorption, which increases the excretion of glucose in the urine.21 Sodium excretion also occurs because the SGLT2 receptor is close to, and works together with, a sodium/hydrogen exchanger, which is a major receptor responsible for sodium reuptake.22
Although SGLT2is lower blood glucose, blood pressure and contribute to diuresis, their benefits in terms of renal and cardiovascular outcomes cannot be solely attributed to these properties, as similar clinical benefits are not seen with other agents that lower glucose, blood pressure or increase natriuresis to similar or greater extent.23,24 The mechanism of action linked to these benefits is complex, and appears to also be a combination of anti-inflammatory and anti-fibrotic effects, a reduction in epicardial fat and a reduction in hyperinsulinaemia.21
Additional evidence also suggests a reduction in oxidative stress, less coronary microvascular injury and improved contractile performance.23 Emerging clinical evidence may also suggest antiarrhythmic properties, which is particularly important given that ventricular arrhythmias and sudden cardiac death is a major cause of death in heart failure patients.21 Some trials have demonstrated a decrease in sudden cardiac death for patients using a SGLT2i.21
The EMPA-REG OUTCOME trial in 2015 was a landmark study, demonstrating that empagliflozin significantly reduced cardiovascular death among high-risk patients with type 2 diabetes, compared to placebo.25 Importantly, it also suggested renal benefits, with less cases of acute renal failure in the empagliflozin group.25 These findings were later confirmed by the EMPA-Kidney (empagliflozin) and DAPA-CKD (dapagliflozin) trials, which both showed reduced rates of death due to renal disease, slower decline in renal function and delayed time to needing dialysis.26–28
The cardiovascular benefits of these medicines went on to be confirmed in further trials including the DAPA-HF (2019), EMPEROR Reduced (2020), EMPEROR Preserved (2021) and DELIVER (2022) trials.16,18,29,30
Key practice points
Knowledge to practice The use of heart failure guideline-directed medical therapy in HFrEF can have a significant impact on patient outcomes. The combination of the ‘four pillars’ (a heart failure beta blocker, an mineralocorticoid receptor antagonist, a renin angiotensin system inhibitor and an SGLT2i) has the ability to improve life expectancy, delay disease progression, decrease heart failure symptoms and improve quality of life.9,10 All patients with HFrEF should be prescribed all four agents unless a contraindication or intolerance exists preventing their use.32
In HFpEF, there are currently no medicines that demonstrate a statistically significant benefit on mortality. However, the use of SGLT2is has been shown to reduce risk of hospitalisation (regardless of diabetic status) and are recommended to be used by guidelines as part of its management, and in the managment of HFmrEF.1,9,14
Heart failure remains a significant health burden, but modern medicines, particularly SGLT2is, can offer significant benefits. Pharmacists play a pivotal role in optimising therapy, ensuring adherence, and providing education to patients. By leveraging their expertise as medication experts, pharmacists can profoundly impact outcomes, improving survival and quality of life for individuals living with heart failure and associated comorbidities.
Case scenario continuedRecognising the benefits of an SGLT2i for both Malcolm’s heart failure and diabetes, you discuss the option of adding an SGLT2i to his regimen, and the potential benefits and risks. Malcolm explains that his main priority is to get his heart failure symptoms under control so that he can play with his grandchildren and exercise comfortably. At Malcolm’s request, you contact his GP, and it is agreed to commence empagliflozin 10 mg daily (after ensuring his eGFR is appropriate). This intervention may help to reduce Malcolm’s risk of death from heart failure, improve his quality of life, delay disease progression, improve diabetic control and assist in helping him achieve his health goals. |
[cpd_submit_answer_button]
Cassie Potts (she/her) BPharm, GradCertChronCondMgt, FANZCAP (Cardiol), AdPhaM is a Senior Clinical Pharmacist with SA Pharmacy and has over 11 years of experience specialising in heart failure as part of the cardiology team at Flinders Medical Centre. She serves on the AdPha Cardiology Leadership Committee and currently practises within the intensive care unit at the Royal Adelaide Hospital.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
[post_title] => SGLT2 inhibitors in heart failure [post_excerpt] => Heart failure remains a significant health burden, but modern medicines, particularly SGLT2is, can offer significant benefits. Pharmacists play a pivotal role in optimising therapy, ensuring adherence, and providing education to patients. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => sglt2-inhibitors-in-heart-failure [to_ping] => [pinged] => [post_modified] => 2025-04-16 15:42:24 [post_modified_gmt] => 2025-04-16 05:42:24 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=28725 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => SGLT2 inhibitors in heart failure [title] => SGLT2 inhibitors in heart failure [href] => https://www.australianpharmacist.com.au/sglt2-inhibitors-in-heart-failure/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 29161 [authorType] => )td_module_mega_menu Object
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[post_content] => Data shows that while community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
Australia is experiencing its worst start to an influenza season, with case numbers surging and vaccination rates falling behind across key age groups.
Amid early peaks, a rise in influenza B cases, and sluggish immunisation uptake, Australian Pharmacist presents a visual snapshot of how the 2025 flu season is unfolding – and what must be done now to prevent a looming public health crisis.
1. Influenza case numbers have reached unprecedented levels to start 2025
This year, influenza cases have reached their highest level in almost a quarter of a century (24 years). To date, there have been 58,203 notifications of laboratory-confirmed influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) – with 2025 Quarter One case reports dwarfing that of previous years.
The flu season started earlier than usual this year, with cases surging sooner than in previous years. Early peaks often lead to higher overall case numbers – particularly when coupled with low immunisation rates.
In 2025, there has been a higher proportion of influenza B cases than in previous years, particularly in school-aged children and young adults, said Professor Anthony Lawler, Australian Government Chief Medical Officer. ‘Influenza B is often more common in children, and can result in more severe infections in children,’ he said.
[caption id="attachment_29144" align="aligncenter" width="500"] Professor Anthony Lawler, Australian Government Chief Medical Officer, got his 2025 vaccine at a Canberra community pharmacy[/caption]
With the northern hemisphere experiencing a severe influenza season, and strains in this region typically migrating south, Rural Doctors Association of Victoria president Louise Manning said the trend was ‘worrying’.
‘We're quite concerned that, given the severity of symptoms and the number of hospitalisations in the northern hemisphere in their winter, that we'll have a similar picture here,’ Dr Manning told the ABC.
2. Pharmacists have had a fast start to influenza vaccination
Data over the last 4 years shows pharmacist-administered vaccines are experiencing continued growth.
Key factors influencing this growth include increased trust in the pharmacy profession to administer vaccines as well as accessibility. With longer operating hours – including evenings and weekends – pharmacies offer greater accessibility, allowing patients to receive influenza vaccinations without appointments or extended wait times. This convenience factor makes pharmacy a more flexible alternative to traditional healthcare settings such as General Practice.
3. Vaccination rates are far too low in children under 5
When it comes to influenza, children aged 0–5 are one of the most vulnerable cohorts – with the high risk of severe complications sometimes leading to hospitalisations, often due to pneumonia, and death.
Despite the risks, vaccination rates remain low in this age cohort, with only 7,398 children aged 0–5 receiving the influenza vaccine so far this year.
Despite the influenza vaccine being covered under the National Immunisation Program for this age group, less than half (45%) of parents are aware that their child can be vaccinated free of charge.
In 2024, only 25.8% of children 6 months to 4 years received an influenza vaccine – with three quarters of this at risk population remaining unvaccinated.
Many parents believe that influenza is not a serious disease or that the vaccine is ineffective or unsafe, with 29% exposed to misinformation and 26% influenced by anti-vaccine sentiment through social media.
Vaccine access can also prove challenging. To boost participation in young children, PSA maintains that there should be ‘no wrong door’ when it comes to vaccination – meaning pharmacists should be able to provide influenza vaccines alongside other childhood immunisations, said Chris Campbell MPS, PSA General Manager Policy and Program Delivery.
‘What [this] does do is increase the convenience for someone to be able to get the vaccine at a time and place of their choosing,’ he said.
‘There should be an increase in vaccine uptake in children under 5 years of age when there’s an opportunity for an entire family to come to the pharmacy and get vaccinated.’
4. Vaccination rates in all cohorts need to improve to stave off a devastating influenza season
The latest data on influenza vaccination coverage in Australia for 2025 reveals concerningly low uptake across all age groups and jurisdictions. Western Australia, Tasmania, and Victoria report particularly low figures at this stage among children 6 months to >5 years and aged 5 to under 15 years, with some states showing uptake as low as 0.1%.
Among patients aged 50 to under 65 years, national coverage sits at 2.8%, with Queensland (4.5%) and South Australia (4.0%) leading the charge. Coverage increases more significantly in the over 65s demographic – with South Australia (14.2%) and Queensland (12.6%) again topping vaccination coverage.
Vaccine manufacturers are also expecting a surge in cases, with CSLSeqirus revealing it has boosted its vaccine output by 100,000 doses this season.
To protect the community from a particularly nasty influenza season, experts have urged people to roll up their sleeves and get vaccinated.
‘If you don't want to get crook get vaccinated,’ Public Health Association of Australia chief executive Terry Slevin said.
‘You're less likely to get crook and if you do get crook, you'll be crook for a shorter period of time ... and reduce the misery.’
[post_title] => Flu cases surge to record highs as vaccination rates stall
[post_excerpt] => While community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
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[post_content] => Aside from administering medicines by injection, Queensland-based community pharmacist Fiona Watson MPS loves tearing up a Latin dance floor.
Tell us about your pharmacy career.
I had a varied early career, moving to North Queensland for a year shortly after I graduated as well as locuming around Australia for a while.
This gave me a great introduction to community pharmacy and a lot of different experiences – both good and bad. When locuming, you develop a clear idea of the factors that contribute to a well-run pharmacy.
I then moved to the United Kingdom where I completed a Certificate in Clinical Pharmacy. You can tell how old I am because I was one of the last pharmacists able to register in the UK with only a month under supervision.
I was a ‘rotational resident pharmacist’, living on-site at the hospital. I covered renal, gastro, cardiology, oncology, aged care, palliative care and surgery wards.
We worked on call overnight, and could get called upon to help with all sorts of different situations – one of the most interesting being calculating the correct dose for the antidote to antifreeze.
More recently, I was very fortunate to be given the opportunity to go into partnership with my mum and sister, both pharmacists, as the managing partner at Redland Bay Wholelife Pharmacy and Healthfoods.
What medicines do you administer by injection?
About 10 years ago, I became a trained vaccinator administering thousands of vaccines during the COVID-19 pandemic.
When Queensland allowed pharmacists to expand the range of medicines they could administer, I completed the Medication Administration course, as I believe this is an essential skill for pharmacists to have.
So many new medications are injectable, and for some patients self-administration just isn’t an option. We were one of the first pharmacies in our area to offer long-acting injectable buprenorphine services, which can be a life-changing option for patients.
Tell us about your administering injections beyond vaccines.
The majority of pharmacists I work with at Redland Bay are trained vaccinators and have completed medicines administration courses. When we come across a new medication that requires administration by injection we collate the available information from the manufacturer and ensure everyone has read it. Many companies, such as Novartis with inclisiran (Leqvio), have reps who are happy to provide additional training.
Once you are comfortable with subcutaneous injections, it’s a matter of familiarising yourself with the different types of devices available. It seemed a logical step for us to provide this service. We have great consult room facilities and it brings variety to our role.
What role do you see pharmacists playing in cardiovascular care in future?
The sky is the limit. We’re on the cusp of a fundamental change in the way Australians receive health care and I hope to see pharmacists embrace the opportunities this will bring.
There’s a workforce crisis and an ageing population, so we need to become more efficient and accessible. If you think about how much the role of a nurse practitioner has changed in the last 10–15 years, you can see where pharmacists have even greater potential. A patient with a diagnosis of heart failure should be able to be titrated to optimum therapy by a pharmacist in a community pharmacy. A patient should have their HbA1c or lipids checked in the pharmacy, with appropriate therapy initiated or adjusted. We should also be actively involved in screening and chronic disease management.
Pharmacy is an incredibly rewarding and enjoyable career, and now is an especially exciting time to be a pharmacist. There is just so much opportunity.
Day in the life of Fiona Watson MPS, Community pharmacist at Redland Bay Wholelife Pharmacy, QLD.
| 5.00am |
Hit the gym I get up and do a HIIT or Muay Thai class most mornings for positive effects on my mental health. Passionate about preventative health care, I see the long-term effects of patients’ lifestyle choices every day. |
| 8.00am |
Open the pharmacy Every day is different. At least two pharmacists are rostered on, ensuring we give each patient the time they need while providing a wide range of different services. |
| 9.00am |
Vaccination service Embarking on a cruise in 2 months, a couple in their 60s asks about COVID-19 vaccines. More than 12 months since their last vaccine they are happy to be vaccinated on the spot. Not wanting more than one vaccine at a time, we book them in for a follow-up appointment in a month for the shingles vaccination. |
| 10.00am |
Collaborative care A local GP phones about a recently discharged mutual patient who’s not coping well on his new medicines. We spend some time with the patient doing a medicine review and setting up his profile for a dose administration aid. |
| 1.00pm |
Lunchtime It’s important that all staff, especially pharmacists, prioritise their breaks. We all need a little downtime to reset and refresh. |
| 1.30pm |
Medicines injection A regular patient comes in for her second dose of inclisiran (Leqvio) after I administered her first 3 months ago. She is happy with the more convenient option than visiting her GP. |
| 3.00pm |
Infection control In a call from our pharmacy car park, we learn a patient has tested positive for COVID-19 and has an e-script. We dispense and counsel over the phone and then deliver out to their car (with appropriate precautions). |
| 6.30pm |
OCP continuance A stressed young woman, with a 2-week wait for a GP appointment, has run out of her pill. She is relieved when seen by a colleague who prescribes Estelle under the Queensland Hormonal Contraceptive Pilot. I dispense it. |
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[post_content] => Vaccination coverage in older Australians remains alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
Older Australians are highly susceptible to serious complications from influenza and COVID-19. But the vaccination rates in patients aged 75 and over are nowhere where they need to be to protect this vulnerable patient cohort from harm, including hospitalisations and death.
The national influenza vaccination rate of patients aged 65 and over currently sits at 7.2%. And in the last 12 months, only 37.7% of Australians aged 75 and over received a COVID-19 vaccination.
But boosting immunisation rates in older Australians is more important than ever. The influenza season started earlier and stronger than usual, with 60,594 cases of influenza reported this year.
As of 10 April, there were also 70 active outbreaks of COVID-19 in residential aged care facilities (RACFs). Last year, case numbers were highest among those most at risk, with notifications peaking in the 75–79, 80–84 and 85+ (12,607).
With GPs not always available to address vaccination gaps in aged care, pharmacists are well positioned to step in and provide this essential service.
In the video above, community pharmacist Lachlan Rose MPS outlines the benefits of providing offsite vaccinations in aged care settings, including financial incentives, workplace variety and the protection of one of the most vulnerable populations.
[post_title] => All pharmacists should consider off-site vaccinations in aged care
[post_excerpt] => Vaccination rates in older Australians are alarmingly low. Off-site services provided by pharmacists are key to closing the gap in aged care.
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[post_content] => The Fair Work Commission’s Expert Panel for pay equity in the care and community sector has today issued its initial decision on the Gender-based undervaluation – priority awards review – making determinations on the Pharmacy Industry Award 2020, which most community pharmacists are employed under.
What did the Expert Panel find?
The Expert Panel found that pharmacists covered by the Pharmacy Industry Award 2020 (and several other awards) have been the subject of gender-based undervaluation.
As a result, the Expert Panel has determined that findings constitute work value reasons, justifying variation of the modern award minimum wage rates across all categories of pharmacists.
What is ‘gender-based undervaluation’?
Gender-based undervaluation considers a range of factors to determine whether minimum award pay rates are undervalued because of assumptions based on gender.
The range of factors considered extends to historical undervaluing, exercise of ‘invisible skills’, exercise of caring work and workforce qualifications, among others.
How does the Expert Panel intend to address the undervaluation?
For pharmacists employed by the Pharmacy Industry Award 2020, the Expert Panel has issued a determination that there will be a total increase in the minimum wage rates of 14.1% over three years.
This increase will be implemented in three equal phases on:
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[post_content] => Case scenario
Malcolm (68 years old, male) visits your pharmacy with a new prescription for sacubitril/valsartan. He mentions he has recently been diagnosed with heart failure with reduced ejection fraction (HFrEF). You review his records and confirm he is still taking metformin/sitagliptin for type 2 diabetes. Malcolm explains that he has taken this for many years, and that his general practitioner has advised him that his blood glucose control needs to be better. He expresses frustration that the shortness of breath from his heart failure limits his ability to exercise and improve his diabetes. Malcolm hopes that starting this new medicine will improve this.
After reading this article, pharmacists should be able to:
|
Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.
Heart failure is a clinical syndrome caused by the inability of the heart muscle to provide adequate cardiac output and/or the presence of increased cardiac pressure. This is due to either a structural or functional abnormality of the heart.1 The clinical syndrome consists of symptoms such as breathlessness and fatigue and may be accompanied by signs of fluid accumulation such as peripheral oedema, elevated jugular venous pressure and pulmonary crackles.1
In many cases, heart failure may be both preventable and treatable. Choice of treatment depends on the type of heart failure present, with management being primarily pharmacological.1
Pharmacists play an essential role in optimising pharmacotherapy for heart failure patients, providing recommendations on safe and effective dose titration and appropriate pharmacological management, as well as providing education, counselling and support for adherence.2
Heart failure remains a global public health issue that affects at least 38 million people worldwide.2 It is a major cause of hospitalisation in Australia and is associated with significant healthcare costs.3
Heart failure has a poor prognosis and results in markedly reduced quality of life.1 Readmission to hospital is extremely common, with about 1 in 3 patients being readmitted in the first month, and up to 15% of patients dying within the first 6 months, after being discharged from hospital.4 By 12 months post-discharge, approximately 25% of heart failure patients will have died.5
Concerningly, due to population aging and increasing prevalence of comorbidities, heart failure hospitalisations could increase by as much as 50% in the next 25 years.1
Categorisation of heart failureHeart failure is categorised according to the measurement of the left ventricular ejection fraction (LVEF). Knowing the LVEF at time of diagnosis is crucial, as this guides treatment.1 Heart failure is categorised as either1,6,7:
HFrEF
For HFrEF, there are effective pharmacological therapies, supported by robust, high-quality evidence. These include what has now become known as ‘the four pillars’, and these collectively make up guideline-directed medical therapy for HFrEF. These include9–11:
All patients with HFrEF should be prescribed all four agents (unless contraindicated or not tolerated), with early initiation being associated with the best outcomes.1,9,10 Other therapies are available as HFrEF progresses, however the ‘four pillars’ are the cornerstone of HFrEF treatment.10
HFmrEF
There is limited evidence to support specific recommendations for the pharmacological management of HFmrEF.1 Some studies suggest that patients with HFmrEF may receive similar benefit from a beta blocker, a mineralocorticoid receptor antagonist and a renin angiotensin system inhibitor as in HFrEF, and SGLT2is have been shown to reduce the risk of cardiovascular death and hospitalisation for heart failure.14 The medicines used to treat HFrEF are often used to treat HFmrEF, however the confidence in prognostic benefits is much less.1,14
HFpEF
For the treatment of HFpEF, no medicines have demonstrated a statistically significant benefit on mortality.1 Recommended treatment consists of15:
The use of an SGLT2i in HFpEF has not been shown to improve mortality to the same extent as for HFrEF. However, an SGLT2i is still recommended because major trials have shown they can still offer some benefits.16,17
The EMPEROR-Preserved trial demonstrated a 21% lower relative risk in the composite of cardiovascular death or hospitalisation for heart failure with the use of empagliflozin in the treatment of HFpEF compared with placebo – a result driven primarily by a reduction in risk of hospitalisation rather than mortality.16 Importantly, this benefit was seen regardless of the diabetic status of the patient.16 This benefit was later reinforced by the DELIVER trial which showed a lower risk of its composite primary outcome of worsening heart failure or cardiovascular death with dapagliflozin use, compared to placebo for those with HFmrEF and HFpEF.18 As a result, SGLT2is have received a strong recommendation for the management of HFpEF in treatment guidelines.1
Additionally, mineralocorticoid receptor antagonists are used in clinical practice because they have been associated with a reduction in risk of hospitalisation for HFpEF patients, as demonstrated by the TOPCAT trial.19
A focus on SGLT2isInitially developed as a medicine used for type 2 diabetes, SGLT2is have become a crucial cardiovascular drug class, as demonstrated above by their role in the management of heart failure, and now have renal and cardiovascular indications irrespective of type 2 diabetic status. This is largely due to results of cardiovascular outcome trials mandated by the United States Food and Drug Administration (FDA) in 2008. These trials led to findings that have significantly changed clinical practice.20 They arose from concerns of cardiovascular risks with certain medicines used for type 2 diabetes, evidence suggesting rosiglitazone may increase the risk of myocardial infarction, and in recognition of the high prevalence of cardiovascular disease in these patients.20
SGLT2is lower blood glucose by inhibiting SGLT2 transporters in the proximal tubules of the kidneys to decrease glucose reabsorption, which increases the excretion of glucose in the urine.21 Sodium excretion also occurs because the SGLT2 receptor is close to, and works together with, a sodium/hydrogen exchanger, which is a major receptor responsible for sodium reuptake.22
Although SGLT2is lower blood glucose, blood pressure and contribute to diuresis, their benefits in terms of renal and cardiovascular outcomes cannot be solely attributed to these properties, as similar clinical benefits are not seen with other agents that lower glucose, blood pressure or increase natriuresis to similar or greater extent.23,24 The mechanism of action linked to these benefits is complex, and appears to also be a combination of anti-inflammatory and anti-fibrotic effects, a reduction in epicardial fat and a reduction in hyperinsulinaemia.21
Additional evidence also suggests a reduction in oxidative stress, less coronary microvascular injury and improved contractile performance.23 Emerging clinical evidence may also suggest antiarrhythmic properties, which is particularly important given that ventricular arrhythmias and sudden cardiac death is a major cause of death in heart failure patients.21 Some trials have demonstrated a decrease in sudden cardiac death for patients using a SGLT2i.21
The EMPA-REG OUTCOME trial in 2015 was a landmark study, demonstrating that empagliflozin significantly reduced cardiovascular death among high-risk patients with type 2 diabetes, compared to placebo.25 Importantly, it also suggested renal benefits, with less cases of acute renal failure in the empagliflozin group.25 These findings were later confirmed by the EMPA-Kidney (empagliflozin) and DAPA-CKD (dapagliflozin) trials, which both showed reduced rates of death due to renal disease, slower decline in renal function and delayed time to needing dialysis.26–28
The cardiovascular benefits of these medicines went on to be confirmed in further trials including the DAPA-HF (2019), EMPEROR Reduced (2020), EMPEROR Preserved (2021) and DELIVER (2022) trials.16,18,29,30
Key practice points
Knowledge to practice The use of heart failure guideline-directed medical therapy in HFrEF can have a significant impact on patient outcomes. The combination of the ‘four pillars’ (a heart failure beta blocker, an mineralocorticoid receptor antagonist, a renin angiotensin system inhibitor and an SGLT2i) has the ability to improve life expectancy, delay disease progression, decrease heart failure symptoms and improve quality of life.9,10 All patients with HFrEF should be prescribed all four agents unless a contraindication or intolerance exists preventing their use.32
In HFpEF, there are currently no medicines that demonstrate a statistically significant benefit on mortality. However, the use of SGLT2is has been shown to reduce risk of hospitalisation (regardless of diabetic status) and are recommended to be used by guidelines as part of its management, and in the managment of HFmrEF.1,9,14
Heart failure remains a significant health burden, but modern medicines, particularly SGLT2is, can offer significant benefits. Pharmacists play a pivotal role in optimising therapy, ensuring adherence, and providing education to patients. By leveraging their expertise as medication experts, pharmacists can profoundly impact outcomes, improving survival and quality of life for individuals living with heart failure and associated comorbidities.
Case scenario continuedRecognising the benefits of an SGLT2i for both Malcolm’s heart failure and diabetes, you discuss the option of adding an SGLT2i to his regimen, and the potential benefits and risks. Malcolm explains that his main priority is to get his heart failure symptoms under control so that he can play with his grandchildren and exercise comfortably. At Malcolm’s request, you contact his GP, and it is agreed to commence empagliflozin 10 mg daily (after ensuring his eGFR is appropriate). This intervention may help to reduce Malcolm’s risk of death from heart failure, improve his quality of life, delay disease progression, improve diabetic control and assist in helping him achieve his health goals. |
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Cassie Potts (she/her) BPharm, GradCertChronCondMgt, FANZCAP (Cardiol), AdPhaM is a Senior Clinical Pharmacist with SA Pharmacy and has over 11 years of experience specialising in heart failure as part of the cardiology team at Flinders Medical Centre. She serves on the AdPha Cardiology Leadership Committee and currently practises within the intensive care unit at the Royal Adelaide Hospital.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
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[post_content] => Data shows that while community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
Australia is experiencing its worst start to an influenza season, with case numbers surging and vaccination rates falling behind across key age groups.
Amid early peaks, a rise in influenza B cases, and sluggish immunisation uptake, Australian Pharmacist presents a visual snapshot of how the 2025 flu season is unfolding – and what must be done now to prevent a looming public health crisis.
1. Influenza case numbers have reached unprecedented levels to start 2025
This year, influenza cases have reached their highest level in almost a quarter of a century (24 years). To date, there have been 58,203 notifications of laboratory-confirmed influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) – with 2025 Quarter One case reports dwarfing that of previous years.
The flu season started earlier than usual this year, with cases surging sooner than in previous years. Early peaks often lead to higher overall case numbers – particularly when coupled with low immunisation rates.
In 2025, there has been a higher proportion of influenza B cases than in previous years, particularly in school-aged children and young adults, said Professor Anthony Lawler, Australian Government Chief Medical Officer. ‘Influenza B is often more common in children, and can result in more severe infections in children,’ he said.
[caption id="attachment_29144" align="aligncenter" width="500"] Professor Anthony Lawler, Australian Government Chief Medical Officer, got his 2025 vaccine at a Canberra community pharmacy[/caption]
With the northern hemisphere experiencing a severe influenza season, and strains in this region typically migrating south, Rural Doctors Association of Victoria president Louise Manning said the trend was ‘worrying’.
‘We're quite concerned that, given the severity of symptoms and the number of hospitalisations in the northern hemisphere in their winter, that we'll have a similar picture here,’ Dr Manning told the ABC.
2. Pharmacists have had a fast start to influenza vaccination
Data over the last 4 years shows pharmacist-administered vaccines are experiencing continued growth.
Key factors influencing this growth include increased trust in the pharmacy profession to administer vaccines as well as accessibility. With longer operating hours – including evenings and weekends – pharmacies offer greater accessibility, allowing patients to receive influenza vaccinations without appointments or extended wait times. This convenience factor makes pharmacy a more flexible alternative to traditional healthcare settings such as General Practice.
3. Vaccination rates are far too low in children under 5
When it comes to influenza, children aged 0–5 are one of the most vulnerable cohorts – with the high risk of severe complications sometimes leading to hospitalisations, often due to pneumonia, and death.
Despite the risks, vaccination rates remain low in this age cohort, with only 7,398 children aged 0–5 receiving the influenza vaccine so far this year.
Despite the influenza vaccine being covered under the National Immunisation Program for this age group, less than half (45%) of parents are aware that their child can be vaccinated free of charge.
In 2024, only 25.8% of children 6 months to 4 years received an influenza vaccine – with three quarters of this at risk population remaining unvaccinated.
Many parents believe that influenza is not a serious disease or that the vaccine is ineffective or unsafe, with 29% exposed to misinformation and 26% influenced by anti-vaccine sentiment through social media.
Vaccine access can also prove challenging. To boost participation in young children, PSA maintains that there should be ‘no wrong door’ when it comes to vaccination – meaning pharmacists should be able to provide influenza vaccines alongside other childhood immunisations, said Chris Campbell MPS, PSA General Manager Policy and Program Delivery.
‘What [this] does do is increase the convenience for someone to be able to get the vaccine at a time and place of their choosing,’ he said.
‘There should be an increase in vaccine uptake in children under 5 years of age when there’s an opportunity for an entire family to come to the pharmacy and get vaccinated.’
4. Vaccination rates in all cohorts need to improve to stave off a devastating influenza season
The latest data on influenza vaccination coverage in Australia for 2025 reveals concerningly low uptake across all age groups and jurisdictions. Western Australia, Tasmania, and Victoria report particularly low figures at this stage among children 6 months to >5 years and aged 5 to under 15 years, with some states showing uptake as low as 0.1%.
Among patients aged 50 to under 65 years, national coverage sits at 2.8%, with Queensland (4.5%) and South Australia (4.0%) leading the charge. Coverage increases more significantly in the over 65s demographic – with South Australia (14.2%) and Queensland (12.6%) again topping vaccination coverage.
Vaccine manufacturers are also expecting a surge in cases, with CSLSeqirus revealing it has boosted its vaccine output by 100,000 doses this season.
To protect the community from a particularly nasty influenza season, experts have urged people to roll up their sleeves and get vaccinated.
‘If you don't want to get crook get vaccinated,’ Public Health Association of Australia chief executive Terry Slevin said.
‘You're less likely to get crook and if you do get crook, you'll be crook for a shorter period of time ... and reduce the misery.’
[post_title] => Flu cases surge to record highs as vaccination rates stall
[post_excerpt] => While community pharmacists have smashed previous early-season influenza vaccination records, national coverage still lags dangerously.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
