As more and better treatments are developed for heart disease, it is becoming more difficult to safely manage care as patients return home from the hospital. A new study led by Vanderbilt researchers highlights growing concern that the period after hospital discharge is a risky time, especially for cardiac patients.
Sunil Kripalani, M.D., M.Sc., associate professor of Medicine and chief of the Section of Hospital Medicine in the Division of General Internal Medicine and Public Health, is the principal investigator of the study published in the Annals of Internal Medicine.
Eight hundred fifty-one patients treated for acute coronary syndromes or heart failure at either Vanderbilt University Hospital or Brigham and Women’s Hospital in Boston were followed for one month after their discharge from the hospital.
The goal was twofold: to study the effect of a pharmacist intervention to reduce medication-related problems and to study the frequency of such problems. Kripalani said the investigators were surprised when they found a high proportion, 50 percent of patients, experienced medication-related problems during the first 30 days after they returned home from the hospital.
“The high frequency of problems with medications surprised us because these two hospitals provide excellent care and have programs in place to help manage medications safely. At other hospitals, the frequency may be even higher,” said Kripalani who is also associate director of the Effective Health Communication Program in the Vanderbilt Center for Health Services Research.
About half of the problems were related to patients not taking their medications correctly, like missing doses or taking the wrong medication, and about half were due to side effects or other reactions to their medications.
“Fortunately, most of the problems related to medications were mild, but about a quarter were serious, for example a patient experiencing a drop in kidney function or having a serious problem with their electrolytes,” Kripalani said.
Half of study participants received usual care as they were discharged from the hospital. Half received the study intervention, which consisted of pharmacist-assisted review and reconciliation of a patient’s medications, counseling of patients before they left the hospital, adherence aids such as pill boxes to organize medications and illustrated medication schedules, and individualized telephone follow-up.
Overall, the intervention was not statistically effective in reducing medication errors across this two-hospital population, though Kripalani noted that some groups of patients benefitted more than others.
“A subgroup analysis showed that patients taking more than about 10 medications, as well as those who had some cognitive impairment or difficulty understanding health information, tended to benefit from the intervention. We also saw a greater benefit among Vanderbilt patients than patients in Boston,” he said.
The patients could be considered fairly typical for heart patients: their average age was 60, and about 20 percent either had some measure of cognitive impairment or had some difficulty understanding health information. Add that to the fact that heart disease remains the No. 1 killer of Americans and the results send a strong message.
“It is important to know the period after hospital discharge is a high-risk time for cardiac patients, because the stakes are so high in this population. We are working to develop additional approaches to support patients and reduce complications in this setting,” Kripalani said.
