Dataset Information

Discontinuity of chronic medications in patients discharged from the intensive care unit.

ABSTRACT:

Background

Intensive care unit (ICU) admission may connote an elevated risk of unintentional chronic medication discontinuation because of its focus on acute illnesses and the multiple care transitions.

Objective

To determine the proportion of patients discharged from the ICU whose previously prescribed chronic medications were unintentionally discontinued during their hospitalization.

Design and participants

Hospital records of consecutive ICU discharges at 1 academic and 2 community hospitals in Toronto, Canada, throughout 2002 were reviewed. Eligible patients were prescribed at least 1 of 6 medication groups before hospitalization: (1) HMG co-A reductase inhibitors (statins); (2) antiplatelets/anticoagulants (aspirin, clopidogrel, ticlopidine, warfarin); (3) l-thyroxine; (4) non-prn inhalers (anticholinergic, beta-agonist, or steroid); (5) acid-suppressing drugs (H2 antagonists and proton pump inhibitors); and (6) allopurinol.

Measurements

Use of explicit criteria to assess the proportion of patients whose previously prescribed chronic medications were unintentionally discontinued at hospital discharge.

Results

A total of 1,402 charts were eligible for the study and 834 had prescriptions for at least 1 of the medication groups. Thirty-three percent (251/834) of patients had 1 or more of their chronic medications omitted at hospital discharge. Multivariable logistic regression analysis found that patients from the academic hospital (adjusted odds ratio [OR] = 0.70, 95% confidence interval [CI] 0.49 to 1.0) and those with medical diagnoses (adjusted OR=0.48, 95% CI 0.31 to 0.75) had a decreased risk for chronic medication discontinuation.

Conclusions

Patients discharged from the ICU often leave the hospital without note of their previously prescribed chronic medications. Careful review of medication lists at ICU discharge could avoid potential adverse outcomes related to unintentional discontinuation of chronic medications at hospital discharge.

SUBMITTER: Bell CM

PROVIDER: S-EPMC1831608 | biostudies-literature | 2006 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Discontinuity of chronic medications in patients discharged from the intensive care unit.

Bell Chaim M CM Rahimi-Darabad Parisa P Orner Avi I AI

Journal of general internal medicine 20060901 9

<h4>Background</h4>Intensive care unit (ICU) admission may connote an elevated risk of unintentional chronic medication discontinuation because of its focus on acute illnesses and the multiple care transitions.<h4>Objective</h4>To determine the proportion of patients discharged from the ICU whose previously prescribed chronic medications were unintentionally discontinued during their hospitalization.<h4>Design and participants</h4>Hospital records of consecutive ICU discharges at 1 academic and ...[more]

PMID: 16918738

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Project description:Background: The postoperative period is critical for a patient's recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (??75,???65 and???55 mmHg), in the absence of intraoperative hypotension (??65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery.Methods: This multi-center retrospective cohort study included specific patient procedures from Optum® healthcare database for patients without intraoperative hypotension (MAP???65 mmHg) discharged to the ICU for???48 h after non-cardiac surgery with valid mean arterial pressure (MAP) readings. A total of 3185 procedures were included in the final cohort, and the association between postoperative hypotension and the primary outcome, 30-day major adverse cardiac or cerebrovascular events, was assessed. Secondary outcomes examined included all-cause 30- and 90-day mortality, 30-day acute myocardial infarction, 30-day acute ischemic stroke, 7-day acute kidney injury stage II/III and 7-day continuous renal replacement therapy/dialysis.Results: Postoperative hypotension in the ICU was associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events at MAP???65 mmHg (hazard ratio [HR] 1.52; 98.4% confidence interval [CI] 1.17-1.96) and???55 mmHg (HR 2.02, 98.4% CI 1.50-2.72). Mean arterial pressures of???65 mmHg and???55 mmHg were also associated with higher 30-day mortality (MAP???65 mmHg, [HR 1.56, 98.4% CI 1.22-2.00]; MAP???55 mmHg, [HR 1.97, 98.4% CI 1.48-2.60]) and 90-day mortality (MAP???65 mmHg, [HR 1.49, 98.4% CI 1.20-1.87]; MAP???55 mmHg, [HR 1.78, 98.4% CI 1.38-2.31]). Furthermore, we found an association between postoperative hypotension with MAP???55 mmHg and acute kidney injury stage II/III (HR 1.68, 98.4% CI 1.02-2.77). No associations were seen between postoperative hypotension and 30-day readmissions, 30-day acute myocardial infarction, 30-day acute ischemic stroke and 7-day continuous renal replacement therapy/dialysis for any MAP threshold.Conclusions: Postoperative hypotension in critical care patients with MAP???65 mmHg is associated with adverse events even without experiencing intraoperative hypotension.

Dataset Information

Discontinuity of chronic medications in patients discharged from the intensive care unit.

Background

Objective

Design and participants

Measurements

Results

Conclusions

Publications

Discontinuity of chronic medications in patients discharged from the intensive care unit.

Similar Datasets

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