A Detailed Description and Assessment of Outcomes of Patients With Hospital Recorded QTc Prolongation

Laksman, Zachary; Momciu, Bogdan; Seong, You Won; Burrows, P E; Conacher, Susan; Manlucu, Jaimie; Leong‐Sit, Peter; Gula, Lorne J.; Skanes, Allan C.; Yee, Raymond; Klein, George J.; Krahn, Andrew D.

doi:10.1016/j.amjcard.2015.01.016

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…We were consequently not able to determine to what degree the increased mortality among the patients with QTc ≥500 ms was due to QT-mediated arrhythmic deaths. In a previous study, Laksman et al 9 . described the prognosis of a cohort of hospitalized patients with extreme QTc interval prolongation.…”

Section: Discussionmentioning

confidence: 99%

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QT prolongation predicts short-term mortality independent of comorbidity

et al. 2019

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Aims A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis. Methods and results Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38–2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1–2: HR 1.62, 95% CI 1.34–1.96; P < 0.001; CCI 3–4: HR 2.50, 95% CI 1.95–3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85–4.96; P < 0.001) but was not associated with 30-day all-cause mortality. Conclusion QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important.

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Section: Discussionmentioning

confidence: 99%

“…This reserve is a product of the interaction between different risk factors, including genetic predisposition 6 , 7 . Several QT prolonging risk factors are identifiable and reversible, including transient QT prolongation during acute non-cardiac illness 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

QT prolongation predicts short-term mortality independent of comorbidity

et al. 2019

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“…On a study of 172 patients, the most common cause for QTc prolongation was QTc interval-prolonging medication and was deemed most responsible in 48% of patients, with 25% of these patients taking ≥ two offending drugs [ 39 ]. Out of seven patients who died with VF, cause of death was myocardial ischemia in three patients and severe heart failure in three patients and one had VF during seizure.…”

Section: Discussionmentioning

confidence: 99%

“…Out of seven patients who died with VF, cause of death was myocardial ischemia in three patients and severe heart failure in three patients and one had VF during seizure. Antidepressants caused QTc prolongation in 53 patients and amiodarone in 36 patients [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Drug Induced Long QT Syndrome: A Systematic Review

et al. 2018

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BackgroundDrug induced long QT syndrome is quite common in daily clinical practice but its impact is unknown.MethodsPubMed and EMBASE databases (until May 2, 2017) were searched to identify studies reporting drug induced long QT syndrome and followed the PRISMA guidelines. The main outcomes measured in these studies were QTc prolongation, ventricular arrhythmias, torsade de pointes (TdP) and death.ResultsOut of 176 non-duplicate reports, 36 studies satisfied inclusion criteria and provided data on patients exposed to drugs that can potentially cause long QT. Totally, 14,756 patients were exposed and 930 patients (6.3%) were found to have QTc prolongation. The number of males was 6,400 and females were 5,723 patients. The mean age of the patients was 43.8 ± 9.36 years. Ventricular arrhythmias were found in 379 patients (2.6%), 26 patients were found to have premature atrial contractions (PACs) and premature ventricular contractions (PVCs). TdP was found in 49 patients (0.33 %), sudden cardiac death (SCD) was found in five patients and 586 patients were found to have all-cause mortality.ConclusionsAround 6% of patients have risk of QT prolongation when exposed but only 0.3% developed TdP and 2.6% developed ventricular arrhythmias. Risk of developing arrhythmias is higher with concomitant use of multiple QT prolonging drugs.

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“…Concurrent use of more than one QT-interval prolonging drug is common and considered a risk factor for QT-interval prolongation and TdP [ 8 – 10 ]. In a recent study in patients with a QT-interval prolongation >550ms, the QT-interval prolongation was attributed in 48% of cases to the medication and involved two or more QT-drugs in 25% of the cases [ 11 ]. In a large population of critically ill patients co-prescribing of QT-drugs occurred in 18.6% of the patients and was associated with a higher mortality rate and longer duration of hospitalization [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Co-Prescription of QT-Interval Prolonging Drugs: An Analysis in a Large Cohort of Geriatric Patients

Schächtele

Tümena²,

Gaßmann³

et al. 2016

PLoS ONE

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BackgroundDrug-induced QT-interval prolongation is associated with occurrence of potentially fatal Torsades de Pointes arrhythmias (TdP). So far, data regarding the overall burden of QT-interval prolonging drugs (QT-drugs) in geriatric patients are limited.ObjectiveThis study was performed to assess the individual burden of QT-interval prolonging drugs (QT-drugs) in geriatric polymedicated patients and to identify the most frequent and risky combinations of QT-drugs.MethodsIn the discharge medication of geriatric patients between July 2009 and June 2013 from the Geriatrics in Bavaria–Database (GiB-DAT) (co)-prescriptions of QT-drugs were investigated. QT-drugs were classified according to a publicly available reference site (CredibleMeds®) as ALL-QT-drugs (associated with any QT-risk) or High-risk-QT-drugs (corresponding to QT-drugs with known risk of Torsades de Pointes according to CredibleMeds®) and in addition as SmPC-high-risk-QT-drugs (according to the German prescribing information (SmPC) contraindicated co-prescription with other QT-drugs).ResultsOf a cohort of 130,434 geriatric patients (mean age 81 years, 67% women), prescribed a median of 8 drugs, 76,594 patients (58.7%) received at least one ALL-QT-drug. Co-prescriptions of two or more ALL-QT-drugs were observed in 28,768 (22.1%) patients. Particularly risky co-prescriptions of High-risk-QT-drugs or SmPC-high-risk-QT-drugs with at least on further QT-drug occurred in 55.9% (N = 12,633) and 54.2% (N = 12,429) of these patients, respectively. Consideration of SmPCs (SmPC-high-risk-QT-drugs) allowed the identification of an additional 15% (N = 3,999) patients taking a risky combination that was not covered by the commonly used CredibleMeds® classification. Only 20 drug-drug combinations accounted for more than 90% of these potentially most dangerous co-prescriptions.ConclusionIn a geriatric study population co-prescriptions of two and more QT-drugs were common. A considerable proportion of QT-drugs with higher risk only could be detected by using more than one classification-system. Local adaption of international classifications can improve identification of patients at risk.

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A Detailed Description and Assessment of Outcomes of Patients With Hospital Recorded QTc Prolongation

Cited by 10 publications

References 19 publications

QT prolongation predicts short-term mortality independent of comorbidity

QT prolongation predicts short-term mortality independent of comorbidity

Impact of Drug Induced Long QT Syndrome: A Systematic Review

Co-Prescription of QT-Interval Prolonging Drugs: An Analysis in a Large Cohort of Geriatric Patients

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