Dahel Hadjer, Tabbara Najla, Burry Lisa, Hornstein Gabrielle, Williamson David, Wang Han Ting
Faculty of Pharmacy, Université de Montréal, QC, Canada.
Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada.
Can J Kidney Health Dis. 2024 Sep 5;11:20543581241276361. doi: 10.1177/20543581241276361. eCollection 2024.
Hospital admission for a critical illness episode creates communication breakpoints and can lead to medication discrepancies during hospital stays. Due to the patient's underlying condition and the care setting, chronic medications such as cardiovascular medication are often held, discontinued, or changed to alternative administration routes. Unfortunately, data on the optimal timing of cardiovascular drug reinitiation among intensive care unit (ICU) survivors are lacking.
The primary objective of this study was to describe the prevalence of chronic cardiovascular medication taken before hospital admission and discontinued at ICU discharge and hospital discharge for critically ill patients. A secondary objective was to assess factors associated with medication discontinuation.
We conducted a multicentered retrospective cohort study at 2 tertiary academic hospitals in Canada. All adult patients taking cardiovascular medication before ICU admission and surviving to hospital discharge between April 1, 2016, and April 1, 2017, were eligible.
The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants' chart review.
We included 352 patients with a median age of 71.0 years. A total of 155 patients (44.03%) had at least 1 cardiovascular medication discontinued during their stay. Our adjusted model uncovered 3 factors associated with cardiovascular medication discontinuation: male sex (odds ratio [OR] = 0.564, 95% confidence interval [CI] = 0.346-0.919), number of cardiovascular medications taken preadmission (OR = 1.669, 95% CI = 1.003-2.777 for 2 medications and OR = 3.170, 95% CI = 1.325-7.583), and the use of vasopressors (OR = 1.770, 95% CI = 1.045-2.997).
Our study uncovered that cardiovascular medication discontinuation for ICU patients is frequent, especially for renin-angiotensin system (RAS) blockers. Data from our study could be used to reinforce site-specific protocols of medication reconciliation and optimization, as well as inform future protocols aimed at RAS blocker reinitiation follow-up.
因危重症发作入院会造成沟通断点，并可能导致住院期间用药差异。由于患者的基础疾病和护理环境，心血管药物等慢性药物常常被停用、中断或改为其他给药途径。遗憾的是，缺乏关于重症监护病房（ICU）幸存者重新开始使用心血管药物的最佳时机的数据。
本研究的主要目的是描述危重症患者入院前服用且在ICU出院时及出院时停用的慢性心血管药物的流行情况。次要目的是评估与药物停用相关的因素。
设计、地点和参与者：我们在加拿大的两家三级学术医院进行了一项多中心回顾性队列研究。所有在2016年4月1日至2017年4月1日期间入院前服用心血管药物且存活至出院的成年患者均符合条件。
研究的主要结局是入院前开具的心血管药物的停用情况。通过查阅参与者的病历对结局进行评估。
我们纳入了352例患者，中位年龄为71.0岁。共有155例患者（44.03%）在住院期间至少停用了1种心血管药物。我们的校正模型发现了3个与心血管药物停用相关的因素：男性（比值比[OR]=0.564，95%置信区间[CI]=0.346-0.919）、入院前服用的心血管药物数量（2种药物时OR=1.669，95%CI=1.003-2.777；OR=3.170，95%CI=1.325-7.583）以及血管升压药的使用（OR=1.770，95%CI=1.045-2.997）。
我们的研究发现，ICU患者停用心血管药物的情况很常见，尤其是肾素-血管紧张素系统（RAS）阻滞剂。我们研究的数据可用于强化特定地点的用药核对与优化方案，并为未来针对RAS阻滞剂重新开始使用的随访方案提供参考。
