Background Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events as well as medication discrepancies or non-adherence with high potential for future harm (potential adverse drug events). Objective The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study sought to determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge. Design Randomized controlled trial with concealed allocation and blinded outcome assessors. Setting Two tertiary care academic hospitals. Patients Adults hospitalized with acute coronary syndromes or acute decompensated heart failure. Intervention Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. Measurements The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable adverse drug events, as well as potential adverse drug events. Results Among 851 participants, 432 (50.8%) experienced 1 or more clinically important medication errors; 23% of such errors were judged to be serious, and 2% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential adverse drug events in 253 (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (IRR=0.92; 95% CI, 0.77 to 1.10) or adverse drug events (IRR=1.09; CI, 0.86 to 1.39). Intervention patients tended to have fewer potential adverse drug events (IRR=0.80; CI, 0.61 to 1.04). Limitations The characteristics of the study hospitals and participants may limit generalizability. Conclusions Clinically important medication errors were present among half of patients after hospital discharge and were not significantly reduced by a health-literacy sensitive, pharmacist-delivered intervention.

ICD-9 code 410.x had high predictive value for identifying AMI. Among those with AMI, smoking and aspirin use was similar in NSAID exposure groups, suggesting these factors will not confound the relationship between NSAIDs and cardiovascular outcomes.

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Background-We implemented a quality improvement initiative to improve hypertension care at Veterans AffairsTennessee Valley Healthcare System. Methods and Results-We implemented multiple interventions among 2 teaching hospitals, 5 community-based outpatient clinics, and 4 contract clinic sites. Goals of the program were to (1) improve measurement and documentation of blood pressure (BP), (2) initiate outpatient patient education, (3) emphasize VA/Department of Defense hypertension treatment algorithms to providers, (4) emphasize external peer review program performance goals, and (5)

Therapeutic target with β blockers in heart failure, i.e., target heart rate reduction or β‐blocker dose, is controversial. To resolve this controversy, the authors studied 152 heart failure patients on β blockers who were divided into four groups based on median peak exercise heart rate reduction as compared with predicted and prescription of at least 50% recommended β‐blocker dose. Event‐free survival (vs. death or assist device placement or urgent transplantation) was compared. Baseline and peak exercise heart rates were 74±14 and 116±21 bpm, respectively. Median heart rate reduction at peak exercise was 35%. When median or higher peak heart rate reduction was achieved, there were no significant survival differences noted between patients on different β‐blocker doses. With below‐median peak heart rate reduction, there was a strong trend toward better event‐free survival with higher β‐blocker doses. In conclusion, the results suggest that higher heart rate reduction is associated with better outcomes for heart failure patients overall and, for patients with persistently elevated heart rates, higher β‐blocker doses provided additional benefit.