INTRODUCTION
Cardiovascular disease (CVD) is the leading causes of death worldwide, with an estimated 17.9 million deaths annually 1. Patients with CVD often have a constellation of comorbidities requiring polypharmacy for symptom control and avoidance of clinical deterioration2. Polypharmacy can lead to drug related problems including drug-drug interactions (DDIs)3, which occur when co-administration of two drugs affects their pharmacological response 4. DDIs can reduce treatment efficacy or increase toxicity, so preventing DDI is critical to optimize treatment outcomes 5.
Patients admitted to intensive care units (ICUs) have serious medical conditions and are often managing multiple co-morbidities requiring polypharmacy, elevating their risk of DDIs 6. DDI avoidance in this population is critically important as fluctuations in drug concentrations and effects may be particularly harmful to ICU patients 7. The prevalence of DDIs in intensive care units ranges from 27% to 95% 8-11, depending on the ICU setting, study population, hospital’s systems for DDI detection, and severity level that is considered a DDI.
DDIs can be prevented by combining systems for DDI detection with pharmacists to manage detected DDIs 12. Computerized order entry systems built into electronic medical records (EMR) that provide automatic DDI warnings enhance patient safety13 by reducing medication errors 14, DDIs and their resultant adverse events 15. At Michigan Medicine (MM) a tertiary care hospital in the United States, the DDI screening tool incorporated within its EMR provide DDI alerts to the pharmacists, nurses and physicians who make decisions based on patient’s individualized therapy.
The primary objective of this study was to determine the prevalence of clinically relevant DDIs in a Cardiac ICU unit at MM, equipped with automated DDI screening within its EMR. A secondary objective was to compare the prevalence of DDIs at MM with a Cardiac ICU at Khyber Teaching Hospital (KTH) in Pakistan, a tertiary care hospital that lacks an EMR and automated DDI screening software.