Development of a risk model for predicting QTc interval prolongation in patients using QTc-prolonging drugs

Abstract

Background Numerous drugs prolong the QTc interval on the ECG and potentially increase the risk of cardiac arrhythmia. This risk is clinically relevant in patients with additional risk factors. Objective The objective was to develop and validate a risk model to predict QTc interval prolongation of eligible ECGs. Setting Spaarne Gasthuis (Haarlem/Hoofddorp, The Netherlands). Method A dataset was created from ECGs recorded in patients using one or more QTc prolonging drugs, in the period January 2013 and October 2016. In the development set, independent risk factors for QTc interval prolongation were determined using binary logistic regression. Risk scores were assigned based on the beta coefficient. In the risk-score validation set, the area under the ROC-curve, sensitivity and specificity were calculated. Main outcome measure QTc interval prolongation, defined as a QTc interval > 500 ms. Results In the development set 12,949 ECGs were included and in the risk-score validation set 6391 ECGs. The proportion of ECGs with a prolonged QTc interval in patients with no risk factors in the risk-score validation set was 2.7%, while in patients with a high risk score the proportion was 26.1%. The area under the ROC curve was 0.71 (95% CI 0.68-0.73). The sensitivity and specificity were 0.81 and 0.48, respectively. Conclusion A risk model was developed and validated for the prediction of QTc interval prolongation. This risk model can be implemented in a clinical decision support system, supporting the management of the risks involved with QTc interval prolonging drugs.

Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

“…People with COVID-19 may have several cardiovascular risk factors, including (a) old age; (b) pre-existing comorbid cardiovascular diseases; (c) use of medical treatments with QTc-prolonging properties, often in combination (e.g., antivirals, chloroquine/hydroxychloroquine and antibiotics); (d) a possible direct cardiotoxic effects of the coronavirus; and (e) electrolyte alterations related to abnormal respiratory gas exchange [ 3 , 20 , 87 , 92 , 97 ]. The most important risk factors of severe arrhythmias, such as torsade de pointes, include the magnitude of QTc prolongation, pre-existing heart disease, female sex, bradycardia, hypokalemia, and other electrolyte abnormalities [ 44 ].…”

Managing drug-induced QT prolongation in clinical practice

“…Bindraban risk model for predicting QTc interval prolongation in patients using QTc-prolonging drugs. 41 A risk model to predict QTc interval prolongation of eligible ECGs. The model was developed by examining ECGs recorded in patients using one or more QTcprolonging drugs.…”

Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

“…The fourth theme, limited availability of protocols, is possibly related to the limited routine use of risk scoring tools in practice. Although there are several QTcI prolongation risk scoring tools published in the literature, 14,[36][37][38] cardiologists in our study were either not aware or argued they had limited time to utilize them in practice. Some studies have shown that risk stratification and implementation of a standardized QTcI monitoring protocol can provide relevant clinical guidance in treatment decisions and result in positive patient outcomes.…”