[Medication-related negative outcomes in patients with permanent atrial fibrillation attended in a hospital emergency department]
- PMID: 29105427
[Medication-related negative outcomes in patients with permanent atrial fibrillation attended in a hospital emergency department]
Abstract
Objectives: To detect the frequency of negative outcomes associated with medication in patients with permanent atrial fibrillation (AF) who are attended in a hospital emergency department, and to assess type and severity of such outcomes related to AF medications as well as the rate of preventable negative outcomes.
Material and methods: Descriptive, observational cross-sectional study in patients with permanent AF who were attended in the emergency department of a tertiary care hospital during a 3-month period. A pharmacist interviewed the patients to record demographic characteristics, health problems, degree of functional impairment, and current drug treatments. An emergency physician and a pharmacist reviewed the patients' questionnaires and medical histories and evaluated them using the Dader method of pharmacotherapeutic follow-up.
Results: Of the 210 patients assessed, 198 entered the final analysis. They had a mean (SD) age of 80.5 (7.3) years, and 114 (57.5%) were women. One handred and thirty-four (67.7%) patients had medication-related negative outcomes; 61 (45.5%) of the outcomes were related to treatment for permanent AF. Twenty-four of these 61 patients (39.3%) had problems affecting safety; 36 (59%) of the problems were caused by drugs to control heart rate. Of the 73 patients with negative outcomes unrelated to AF medication, 34 (46.6%) were related to necessary medications and 38 (52.1%) were taking antibiotics. The frequencies of avoidable negative outcomes were significantly different between the group of patients with problems related to drug therapy for AF (where 55.7% were due to medications considered unnecessary) and those with problems unrelated to AF medications (where 78.1% were from avoidable medications) (P=.010). However, the level of seriousness was similar.
Conclusion: Nearly two-thirds of patients with permanent AF who come to the emergency department have a medication- related negative outcome that may or may not be related to AF treatment. Problems from drugs taken for reasons other than AF could more easily be avoided.
Objetivo: Detectar la frecuencia de resultados negativos asociados a la medicación (RNM) en los pacientes con fibrilación auricular permanente (FAP) atendidos en un servicio de urgencias hospitalario (SUH), y evaluar su tipología, evitabilidad y gravedad en función de su relación con la terapia farmacológica para la fibrilación auricular (FA).
Metodo: Estudio observacional descriptivo de una serie de casos con análisis transversal que incluyó a los pacientes atendidos con FAP en un servicio de urgencias (SU) de un hospital de tercer nivel durante 3 meses. Un farmacéutico entrevistó a los pacientes recogiendo datos demográficos, problemas de salud, grado de dependencia y terapia farmacológica. Un grupo evaluador, formado por un urgenciólogo y un farmacéutico, revisaron los cuestionarios y las historias clínicas para la evaluación de los RNM según el método Dáder.
Resultados: Del total de 210 pacientes evaluados se incluyeron finalmente 198 pacientes con una edad media de 80,5 (DE 7,3) años, de los cuales 114 (57,5%) fueron mujeres. Ciento treinta y cuatro (67,7%) pacientes sufrieron un RNM, de los cuales 61 (45,5%) estaban relacionadas con el tratamiento de la FA (RNM-RTFA). De los 61 pacientes con RNM-RTFA, 24 (39,3%) fueron RNM de seguridad y 36 (59%) estaban causados por los fármacos para el control de la frecuencia. De los 73 pacientes con RNM no relacionadas con el tratamiento de la FA (RNM-NRTFA), 34 (46,6%) fueron RNM de necesidad y 38 (52,1%) eran por antibióticos. Entre los dos grupos, hubo diferencias estadísticamente significativas en cuanto a la evitabilidad (RNM-RTFA 55,7% vs RNM-NRTFA 78,1%; p = 0,010), pero no para la gravedad (p = 0,265).
Conclusiones: Casi dos tercios de los pacientes con FAP que acuden a un SUH sufren un RNM relacionado o no con la medicación específica para la FA, siendo más evitables los RNM del grupo de fármacos no relacionados con el tratamiento de esta enfermedad.
Keywords: Emergency health services; Fibrilación auricular permanente; Método Dáder; Permanent atrial fibrillation; Pharmacotherapy, negative outcomes; Resultados negativos asociados a la medicación; Servicio de urgencias; Tratamiento farmacológico.
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