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RESEARCH PRODUCT

Severe iatrogenic admissions in a coronary care unit:

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Introduction: Iatrogenic complications are defined as adverse drug reactions or complications induced by non drug interventions, such as cardiac devices or stimulation techniques. Iatrogenic complications occurring during hospital stay are known to be associated with increased hospital length of stay and mortality. Only few data are available on iatrogenic as cause of hospital admission, particularly in coronary care unit. In patient admitted in coronary care unit for iatrogenic, we aimed a) to analyse their prevalence, type and characteristics, b) to analyse their in-hospital length of stay and mortality and c) to evaluate the predictive factors of severity and mortality. Methods: From 1st April 2008 to 31 December 2012, all the consecutive admissions caused by iatrogenic complications at the coronary care unit were prospectively included and classified in 2 groups: 1) pharmacological iatrogenic (beta-blockers, digoxin, calcium channel blockers, amiodarone, several anti-arrhythmics, anticoagulants, antiplatelets and others), 2) non pharmacological iatrogenic (pace-maker, cardiovertor-defibrillator, radiofrequency, coronary angiography and cardiac surgery including valve surgery). We excluded patients with intentional overdose. We also compared patients according to the severity (group 1 patients needing a monitoring; and group 2: patients who needed an invasive procedure or vasoactive amine). Results: Among 8924 patients admitted in coronary care unit (CCU) during the inclusion period, 359 (4.0%), were admitted for iatrogenic complication, 191 (53%) in group 1 and 168 (47%) in group 2. In group 2, there was more men (117 (70%) vs. 101 (53%), p<0.001), patients were younger (69±16 vs. 74±14, p< 0.001) and share similar severity 67% vs. 62% with group 1 (p= 0.309). The mortality was similar for both groups (Non pharmacological group: 13 (7.7%) vs. pharmacological group: 11 (5.8%), p=0.454)). When compared group 2 vs group 1, there is no difference for the number of drugs (7±3 vs. 8±4, p= 0.202), CCU length of stay (5±4 vs. 5±6 days, p= 0.526), respectively. When compared with all the patients hospitalised in CCU during the inclusion period, patients admitted for a iatrogenic cause had longer mean length of stay (8.9±11.3 vs 12.8±12.2 days, p<0.001) and similar mortality (8.4 vs 6.7%, p=0.344). Conclusion: Iatrogeny represent a non negligible cause of admission in CCU. The length of stay of these patients is higher than current stay. Further studies are needed to determinate the origin of mortality and to better characterize patients at risk of Iatrogeny.