Drug-Drug Interactions in Cardiovascular Patients
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Cardiovascular Patients: Safety and Medication
Since the publication of To Err is Human, there is increased awareness of medical and medications error. LaPoint, Nancy, and Jollis sampled 14,983 pharmacy interventions between 1995 and 2000. Of those sampled, nearly 5,000 were medication errors and of those errors, about 41% were cardiovascular medication errors. Cardiovascular disease is a critical topic in the United States healthcare system today. According to the Centers for Disease Control and Prevention (CDC), about 610,000 people die every year of heart disease in the United States.
According to the AHA’s report, in-hospital medication errors contribute to nearly 44,000 to 98,000 deaths each year—and cardiovascular medications remain to be the majority of those errors.
Safety Concerns in Cardiovascular Disease Patients
Cardiovascular disease is the leading cause of morbidity and mortality in the United States, especially in those with diabetes. Patients with diabetes often present with other atherosclerotic diseases such as renal vascular disease, peripheral vascular disease, and others. Comorbidities increase their risk nearly two-fold than those without diabetes. Much effort has been put forth for this population. Drug manufacturers have been pushing for clinical trials for patients with cardiovascular diseases and type 2 diabetes in order to pinpoint effective indications and potential contraindications.
Patients with comorbidities are especially vulnerable to drug-drug interactions. For example, non-selective beta-blockers (often used in patients with hypertension or arrhythmia) may increase lipid levels. Thiazides, a diuretic that has been shown to significantly improve the outcome of those with cardiovascular diseases, are also contraindicated in those with a high lipid profile.
Despite the widespread knowledge of such indications and contraindications, medication errors (especially in the cardiac patient groups) remain very high. According to the American Heart Institute (AHA), older adults are at a greater risk of morbidity and/or mortality if they do not receive their recommended medications such as angiotensin-converting enzyme inhibitors (ACEI), amiodarone, or statins—all of which have been scientifically proven to reduce the risk of mortality for cardiovascular patients.
Dr. David Nash of Thomas Jefferson University states that 85% of the time, a failure is due to a poor process. According to Dr. Nash, an important mistake many healthcare organizations make is to close the “feedback loop.” Such a loop is important in providing information on the performance of an individual to that individual. Counseling is provided to ensure that the healthcare worker is fit with the proper tools identifying which systems and methods failed and which systems and methods could be used in a more effective fashion. Bringing any failure to attention is important in identifying a system failure, and therefore, improving upon that error.
Concluding Thoughts
We have seen a significant shift from hospital-centered care to patient-centered and then family-centered healthcare delivery methods (Laureate, 2010). These methods may be effective considering that discharged patients will be in the hands of the family. Therefore, it is the duty of healthcare workers not only to encourage patients to become involved in their healthcare delivery but also to educate and encourage the patients’ families to become part of the overall care. For patients with cardiovascular diseases, the overall care consists of ensuring accurate knowledge of the outpatient medication regiment.
Azimova, Kamola, Zinnia San Juan, and Debabrata Mukherjee (2014). Cardiovascular Safety Profile of Currently Available Diabetic Drugs. The Ochsner Journal. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295739/
Centers for Disease Control and Prevention (2015). Heart Disease Facts. Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/facts.htm
Council on Clinical Cardiology and Council on Cardiopulmonary Care (2010). Medication Errors in Acute Cardiovascular and Stroke Patients. American Heart Association. http://circ.ahajournals.org/content/121/14/1664.full
Galt, Kimberly and Karen A. Paschal (2011). Foundations in Patient Safety for Health Professionals. Jones and Bartlett Publishers. Print.
LaPoint, Nancy, and James Jollis (2003). Medication Errors in Hospitalized Patients. National Institutes of Health. http://www.ncbi.nlm.nih.gov/pubmed/12824096
Laureate Education, Inc. (Executive Producer). (2010). Quality assessment and improvement: Strategies and techniques to improve patient safety and quality. Baltimore: Author.
Tziomalos, K., Athyros, V., Karagiannis, A. & Mikhailidis, D. (2011). Dyslipidemia induced by drugs used for the prevention and treatment of vascular diseases. The Open Cardiovascular Medicine Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137137/
