Negative outcomes associated with medication in patients with chronic atrial fibrillation who present at the emergency department

• Published in: Journal of clinical pharmacy and therapeutics Vol. 40; no. 4; pp. 452 - 460
• Main Authors: Torres-Degayón, V., Torres-Murillo, J. M., Baena-Parejo, M. I., Muñoz-Villanueva, M. C., Montes-Redondo, G., Calleja-Hernández, M. A., Faus-Dáder, M. J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-08-2015; Hindawi Limited
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - drug therapy; Chronic Disease; Cross-Sectional Studies; Dader method; drug therapy; Drug-Related Side Effects and Adverse Reactions - epidemiology; emergency department; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Male; negative outcomes associated with medication; Outcome Assessment (Health Care); permanent atrial fibrillation; Severity of Illness Index; permanent atrial fibrillation; drug therapy; emergency department; negative outcomes associated with medication; Dader method
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12289

Summary
What is known and Objective
Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided.
Methods
This descriptive, cross‐sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts.
Results and Discussion
Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood‐forming organs.
What is new and Conclusion
A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.
Distribution of the severity of the negative outcomes associated with medication by categories (necessity, effectiveness and safety). NOAM, negative outcomes associated with medication. This figure shows that there was a high percentage of serious NOAM (classified as severe and fatal) in every category (necessity, effectiveness and safety) in patients with chronic atrial fibrillation who present at the emergency department.