Key result
Among 352 ICU survivors, 44.03% had at least one chronic cardiovascular medication discontinued at hospital discharge, with renin-angiotensin system blockers being most frequently discontinued.
Why the study?
Critical illness often leads to holding or discontinuing chronic cardiovascular medications, but data on the optimal timing of cardiovascular drug reinitiation among ICU survivors are lacking.
Cohort (n=352)
Yes
Discontinuation of chronic cardiovascular medications, particularly renin-angiotensin system blockers, is highly prevalent among ICU survivors at hospital discharge, highlighting a need for improved medication reconciliation protocols during care transitions.
Discontinuation of chronic cardiovascular medications at ICU discharge may signal transition gaps; leaves open effects on outcomes and optimal reconciliation strategies.
Importance: 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. Objective: 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. Design setting and participants: 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. Main outcomes and measures: The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants' chart review. Results: 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). Conclusion: 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.
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Dahel et al. (2024) conducted a cohort in Critically ill patients taking cardiovascular medication prior to ICU admission (n=352). Intensive care unit admission was evaluated on Discontinuation of cardiovascular medication prescribed before ICU admission at hospital discharge. Among 352 ICU survivors, 44.03% had at least one chronic cardiovascular medication discontinued at hospital discharge, with renin-angiotensin system blockers being most frequently discontinued.
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