Table 2.
CV medication harm within hospitals.
| Author | Type of study | Patient population/(n) | Country | Type of medication harm | Incidence | % medication harm caused by CV medications | CV medications ranked against other drug classes | Outcomes |
|---|---|---|---|---|---|---|---|---|
| Systematic reviews and meta-analyses | ||||||||
| Beijer et al. 73 | MA | All patients/(n = 68 studies, 123,794 admissions) | – | ADR a | 4.9% of admissions (mean) | CV identified in 38 studies | NR | Preventable: 28.9% (mean) from 12 studies |
| Alhawassi et al. 41 | SR of POS/ROS | ⩾18 years/(n = 14 studies) | – | ADR | 11.5% (median) | CV medications identified as leading cause (% NR) | NR | NR |
| Laatikainen et al. 74 | MA and SR of nine studies | All patients/(n = 9 studies, 46,626 patients) | – | ADE
a
ADR FADR |
ADEs: 21.6% (mean) ADRs: 23.4% (mean) FADRs: 9.6% (mean) | 16% of ADEs 20% of ADRs 9% of FADR (from three studies) |
2nd 3rd 4th |
Preventable: 12.0–75% Severity: 9.6% fatal (mean from 3 studies) |
| Literature reviews | ||||||||
| Wiffen et al. 44 | LR of 69 studies (54 POS and 15 ROS) | All patients/(n = 412,000) | – | ADR | 3.7% of inpatients | Digoxin (22 studies) Diuretics (15 studies) identified as leading cause of harm (% NR) | NR | Cost: £380 million |
| Kanjanarat et al. 70 | LR of 10 studies | All patients/(n = 10 studies, 117,259 patients) | – | pADE a | 1.8% (median) | 17.9% of pADEs | 1st | NR |
| Levkovich et al. 75 | Scoping LR | Hospitalised patients/(n = 12 studies) | – | Emergency call/respiratory arrest | 5–37% of deteriorations | CV medications identified as leading cause (% NR) | NR | NR |
| Observational/cohort and case-control studies | ||||||||
| Leape et al. 4 | RCS | All patients/(n = 30,195) | USA | AEs (including drug complications a ) | 19% of adverse events | 8.5% of drug complications | 4th | Severity: 14.1% caused serious disability |
| Wilson et al. 5 | RCS | All patients/(n = 14,000 admissions) | AU | AEs including drug related a | 10.8% of AEs | 11.6% (CV) 8.2% (antihypertensive) of drug-related AEs |
3rd (CV) 6th (anti-HTN) b |
Mortality: 8%, Severity: 17% caused permanent disability |
| Classen et al. 76 | Matched CCS | All patients/(n = 1580 cases and 20,197 controls) | USA | ADE a | 2.43% of patients | NR | 2nd (digoxin) | Cost: increase of $2262 linked with ADE (p < 0.001) Severity: 5.8% severe, 3.5% fatal LOS: increased (p < 0.01) |
| Doucet et al. 77 | PCS | ⩾70 years admitted to geriatric unit/(n = 2814) | France | ADE | 15.2% | 43.7% of ADEs | 1st | NR |
| Al-Tajir et al. 78 | PCS | All patients/(n = 736 ADE reports) | UAE | ADE | NR | 16.5% | 3rd | Preventable: 13.8% of ADEs |
| Passarelli et al. 51 | PCS | ⩾60 years admitted to internal medicine/(n = 186) | Brazil | ADR | 46.2% of patients | 11.8% (diuretics) 7.6% (captopril) of ADRs |
1st (diuretics) 2nd (captopril) |
LOS: increased (p < 0.001) |
| Cecile et al. 72 | RCS | Patients ⩾65 years/(n = 823) | France | ADEa,c | 13.6% of patients | 23.2% (CV) 15.2% (diuretics) of ADEs c |
1st (CV) 4th (diuretics) |
NR |
| Trivalle et al. 79 | Randomised prospective trial | Patients ⩾65 years/(n = 576) | France | ADE a | 223 ADEs identified | 19.8% of ADEs | 1st | NR |
| Morimoto et al. 80 | PCS | Patients ⩾15 years/(n = 3459 admissions) | Japan | ADE | 21% of patients | 5.1% of ADEs | 5th | Mortality: 1.6% of ADEs Severity: 4.9% life threatening |
| Conforti et al. 57 | PCS | Patients ⩾65 years/(n = 1023) | Italy | ADR | 25% of patients | 32.4% of ADRs | 1st (diuretics) | LOS: increased (no p value reported) |
| O’Connor et al. 71 | PCS | Patients ⩾65 years/(n = 513) | Ireland | ADR | 26% of patients | 25% (diuretics) 17% (anti-HTN) of ADRs |
1st (diuretics) 4th (anti-HTN) |
Severity: 24% were severe |
| Parikh et al. 81 | RCS | All patients/(n = 57,205) | AU | ADE a | 0.7% of admissions | 9% of ADEs | 4th | NR |
| Paradissis et al. 22 | RCS | Patients ⩾65 years/(n = 164) | AU | ADE a | 7.3% of patients | 44% of ADEs | 1st | LOS: increased (p = 0.043) |
| Rojas-Velandia et al. 82 | RCS | Patients admitted to ICU/(n = 697 patients) | Colombia | ADR | 11.0% of patients | 33.3% | 2nd | Preventable: 44% of ADRs |
| Robb et al. 83 | RCS | All patients/(n = 2659) | New Zealand | ADE/MRHa,d | 28% of patients e | 5.4% of MRH | 5th (furosemide) 8th (metoprolol) |
Severity: 1.6% permanent disability or death, 2.4% required an intervention to sustain life |
a
Includes medication errors.
b
n.b. leading drug type was ‘other’.
c
Includes ADEs causing admission; inpatient rate not separated in analysis.
d
terms used interchangeably.
e
Includes ADEs causing admission, readmission and inpatient ADEs.
ADE, adverse drug event; ADR, adverse drug reaction; AE, adverse events; antiHTN, antihypertensives, AU, Australia; CCS, case-control study; CV, cardiovascular; FADR, fatal ADR; ICU, intensive care unit; LOS, length of stay; LR, literature review; MA, meta-analysis; MRH, medication-related harm; NR, not reported; OS, observational study; pADE, preventable ADE; pADR, preventable ADR; PCS, prospective cohort study; POS, prospective observational study (includes PCS/CCS/cross-sectional study); RCS, retrospective cohort study; ROS, retrospective observational study (includes RCS/CCS/cross sectional study); SR, systematic review; USA, United States of America.