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.