Optimizing Subsequent CARdiovascular Medication Reintroduction in the Intensive Care Unit.

Area of Science:

• Clinical Pharmacy
• Critical Care Medicine
• Cardiovascular Pharmacology

Background:

• Hospital admissions for critical illness disrupt medication regimens, leading to potential discrepancies.
• Chronic cardiovascular medications are often discontinued or altered in intensive care units (ICUs).
• Optimal timing for cardiovascular drug reinitiation post-ICU is not well-established.

Purpose of the Study:

• To determine the prevalence of chronic cardiovascular medication discontinuation in critically ill patients.
• To identify factors associated with cardiovascular medication discontinuation upon ICU and hospital discharge.

Main Methods:

• Multicentered retrospective cohort study at two tertiary academic hospitals in Canada.
• Included adult patients on cardiovascular medications before ICU admission who survived to hospital discharge.
• Assessed medication discontinuation via chart review.

Main Results:

• 352 patients were included; 44.03% had at least one cardiovascular medication discontinued.
• Factors associated with discontinuation included male sex, higher number of pre-admission cardiovascular medications, and vasopressor use.
• Renin-angiotensin system (RAS) blockers were frequently discontinued.

Conclusions:

• Cardiovascular medication discontinuation is common among ICU survivors.
• Findings support reinforcing medication reconciliation protocols and developing strategies for RAS blocker reinitiation.
• Further research is needed on optimal cardiovascular drug reinitiation timing.