Post-Discharge Discontinuation of Chronic Cardiovascular Medications and 30-Day Outcomes in Public Hospitals in Nasiriyah, Iraq: A Multicentre Prospective Observational Study
College of Health and Medical Technologies, Sawa University, Samawah, Al-Muthanna, Iraq.
Research Article
Open Access Research Journal of Biology and Pharmacy, 2026, 17(01), 001-012.
Article DOI: 10.53022/oarjbp.2026.17.1.0029
Publication history:
Received on 28 March 2026; revised on 04 May 2026; accepted on 07 May 2026
Abstract:
Background: The discontinuation of chronic cardiovascular medications after hospital discharge is a relatively unacknowledged risk to treatment continuity. In settings with fragile health systems where continuity of care, access to medications, and follow-up services are often lacking, evidence is limited to resource-limited and conflict-affected settings.
Objective: The primary objective was to assess the prevalence of discontinuation of chronic cardiovascular medications after hospital discharge. Secondary objectives included identifying factors associated with post-discharge medication discontinuation and exploring the association between medication discontinuation and 30-day post-discharge clinical outcomes.
Methodology: This was a multicentre prospective observational study conducted in three public hospitals in Nasiriyah, Iraq. Adult patients who were discharged with a prescription for at least one chronic cardiovascular medication were followed 30 to 35 days after hospital discharge. The primary outcome was the discontinuation of at least one chronic cardiovascular medication within 30 days after hospital discharge. Secondary outcomes included hospital readmission within 30 days, emergency department (ED) visit within 30 days, and all-cause mortality within 30 days. Bivariate analyses and multivariable logistic regression were used to identify patient-, medication-, and hospital-level factors that were independently associated with medication discontinuation.
Results: Four hundred fifteen patients were included in the analysis. 152 (36.6%) patients discontinued at least one chronic cardiovascular medication within 30 days after hospital discharge. Hospital readmission within 30 days occurred in 36 patients (23.7%) in the discontinuation group, and 41 patients (27.0%) in the same group had an ED visit. There were no readmissions or ED visits in the continuation group. The 30-day all-cause mortality was low in both groups. In the adjusted analysis, no formal education was associated with lower odds of medication discontinuation in comparison to higher education (OR 0.27, 95% CI 0.10–0.72; p = 0.009). Age, number of medications at discharge, adherence score, and health-literacy score were not significant independent predictors. Pharmacist counselling and scheduled follow-up were also not independently associated with medication discontinuation after adjustment.
Conclusion: More than one-third of the patients discontinued at least one chronic cardiovascular medication within 30 days after hospital discharge. Medication discontinuation was associated with a concentration of early readmissions and ED visits, highlighting the vulnerability of the immediate post-discharge period. The findings highlight the importance of efforts to strengthen post-discharge continuity of care and form the basis for further research on targeted interventions to reduce early medication discontinuation in fragile health systems.
Keywords:
Cardiovascular medications; Hospital discharge; Medication discontinuation; Continuity of care; Readmission; Emergency department visits; Iraq; Fragile health systems
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Copyright © 2026 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0