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Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):437-42. doi: 10.1161/CIRCOUTCOMES.108.846493. Epub 2009 Aug 18.

Iatrogenic adverse events in the coronary care unit.

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Division of Cardiology, Department of Medicine, and the Cardiac and Vascular Program, McMaster University, Hamilton, Ontario, Canada.



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.


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.


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.

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