title: [Admissions to a coronary care unit for severe iatrogenic conditions: a prospective study of 7244 patients].
abstract: BACKGROUND
  Iatrogenic complications are defined as adverse drug reactions or complications induced by non-drug interventions, such as cardiac devices or stimulation techniques. Iatrogenic complications occurring during hospital stay are known to be associated with increased hospital length of stay and mortality. Only few data are available on iatrogenic as cause of hospital admission, particularly in coronary care unit. In patient admitted in coronary care unit for iatrogenic, we aimed: (a) to analyse their prevalence, type and characteristics, (b) to analyse their in-hospital length of stay and mortality and (c) to evaluate the predictive factors of severity and mortality.
  
  
  METHODS
  From 1st April 2008 to 31 January 2012, all the consecutive admissions caused by iatrogenic complications at the coronary care unit were prospectively included and classified in two groups: (1) pharmacological iatrogenic (beta-blockers, digoxin, calcium channel blockers, cordarone, several antiarrhythmic , anticoagulants, antiplatelets and others), (2) non-pharmacological iatrogenic (pacemaker, cardioverter-defibrillator, radiofrequency, coronary angiography and cardiac surgery including valve surgery). We excluded patients with intentional overdose. We also compared patients according to the severity (group 1: patients who just need a monitoring; and group 2: patients for whom there was invasive procedure or for whom we used vasoactive amine).
  
  
  RESULTS
  Among 7244 patients admitted in coronary care unit during the inclusion period, 250 (3.4%) were admitted for iatrogenic complication, 136 in pharmacological group and 114 in non-pharmacological group. In non-pharmacological group, there was more men: 73.7% vs. 47.8% (P < 0.001), patients are younger: 67.3 ± 13.2 vs. 75.4 ± 15.8 (P < 0.001) and are more severe: 80.4% in group 2 vs. 69.4% (P = 0.05). The mortality in this group tends to be more important. According to the severity, there is no difference about drugs: 7.4 ± 3.4 vs. 6.8 ± 2.9 (P = 0.184) and are staying longer in hospital: 4.7 ± 3.2 days vs. 3.4 ± 2.4 (P = 0.009) for coronary care unit length of stay and 15 ± 13.7 vs. 10 ± 9.8 (P = 0.003) for total length of stay.
  
  
  CONCLUSIONS
  Iatrogenic represent a non-negligible cause of admission in coronary care unit, which associated with significant mortality (8.8%) and with a trend toward a higher length of stay. Further studies are needed to determinate the origin of mortality and to better characterize patients at risk of iatrogenic.
authors.affiliation: Service de cardiologie, CHU Bocage, boulevard Maréchal-de-Lattre-de-Tassigny, 21034 Dijon cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Bogé
authors.forename: L
authors.initials: L
authors.lastname: Lorgis
authors.forename: A
authors.initials: A
authors.lastname: Dautriche
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.forename: A
authors.initials: A
authors.lastname: Gudjoncik
authors.forename: P
authors.initials: P
authors.lastname: Buffet
authors.forename: I
authors.initials: I
authors.lastname: L'Huillier
authors.forename: M
authors.initials: M
authors.lastname: Zeller
authors.forename: C
authors.initials: C
authors.lastname: Sgro
authors.forename: Y
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate