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Original Articles

Iatrogenic Adverse Events in the Coronary Care Unit

Sherali A. Rahim, MD; Anita Mody, MD; Jennifer Pickering, BScPhm; P.J. Devereaux, MD, PhD and Salim Yusuf, MD, DPhil

From the Division of Cardiology, Department of Medicine (S.A.R., A.M., P.J.D., S.Y.), and the Cardiac and Vascular Program (J.P.), McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.

Correspondence to Sherali Rahim, MD, McMaster University, 1200 Main St W, Room 2C8, Hamilton, Ontario, Canada, L8N 3Z5. E-mail sherali.rahim{at}utoronto.ca

Received December 25, 2008; accepted June 16, 2009.

Background— Although our understanding of medical adverse events has increased substantially over the last decade, little is known about iatrogenic adverse events (IAEs) in the coronary care unit (CCU). We sought to determine the frequency and potential preventability of IAEs in the CCU of a tertiary care center.

Methods and Results— We undertook a retrospective cohort study evaluating the hospital charts of consecutive patients admitted to the CCU at Hamilton General Hospital (Ontario, Canada) from November 1, 2005, to January 1, 2006. We used a priori developed definitions to determine whether patients suffered an IAE and whether it was potentially preventable. We included 194 patients, and 99 (51%; 95% CI, 44% to 58%) patients had at least 1 IAE, of which 45 (45%; 95% CI, 36% to 55%) were judged potentially preventable. Bleeding (14/51, 27%; 95% CI, 17% to 41%) was the most common potentially preventable IAE and was more common than recurrent ischemic events (4/51, 8%; 95% CI, 3% to 19%). Of the patients who died in the hospital, 9 of 17 (53%; 95% CI, 31% to 74%) had an IAE that was causally related to their death, of which 6 (67%; 95% CI, 35% to 88%) were judged potentially preventable.

Conclusions— The present study suggests that IAEs, especially bleeding, are common in the CCU setting and more frequent than recurrent ischemic events. These results suggest the need for large multicenter studies to evaluate in CCUs the rates of IAEs, their causes, and potential preventability.

Key Words: iatrogenic disease • outcome assessment

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