title: Negative outcomes associated with medication in patients with chronic atrial fibrillation who present at the emergency department.
abstract: OBJECTIVE
  Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided.
  
  
  METHODS
  This descriptive, cross-sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts.
  
  
  CONCLUSIONS
  Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood-forming organs.
  
  
  CONCLUSIONS
  A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.
authors.affiliation: Pharmacy Department, Ceuta University Hospital, Ceuta, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Torres-Degayón
authors.affiliation: Emergency Department, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Torres-Murillo
authors.affiliation: Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
authors.forename: M I
authors.initials: MI
authors.lastname: Baena-Parejo
authors.affiliation: Methodological Support Unit, The Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Muñoz-Villanueva
authors.affiliation: Emergency Department, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Montes-Redondo
authors.affiliation: Pharmacy Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Calleja-Hernández
authors.affiliation: Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Faus-Dáder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index
keywords: Dader method; drug therapy; emergency department; negative outcomes associated with medication; permanent atrial fibrillation