High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia

Abstract

AIMSMedication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. METHODSPatients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS-22. RESULTSA total of 55 932 patients were chronically receiving QT-prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT-prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT-prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT-prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). CONCLUSIONSThe widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Some drug classes are considered to be one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and this serious adverse drug reaction has gained attention over time.• The older adult population using medication related to LQTS and TdP has multiple risk factors that may increase the probability of these adverse outcomes. • Studies have identified risk patterns for TdP in acute care but data on their chronic use are scarce. WHAT THIS STUDY ADDS• 10.6% of the older adult population in Columbia was found to consume chronically drugs with QT interval-prolonging potential. Most of these patients were consuming drugs with a conditional risk, but 98% of them had at least one risk factor for LQTS and TdP.• Use of QT-prolonging drugs for psychiatric and neurological disorders was higher among women, and increased with age. In addition, the use of this type of drug was associated with an increase in the risk of major polypharmacy, and of receiving concurrent use of more than one QT drug and high doses.• Clinicians should keep in mind that common cardiovascular and noncardiovascular drugs are associated with LQTS and TdP, and should routinely assess the associated risk factors, including an electrocardiographic study before and after prescribing these drugs.

Drug use and torsades de pointes cardiac arrhythmias in Sweden: a nationwide register-based cohort study

“…Overall, the results are in line with the concept of ‘reduced repolarisation reserve’, introduced by Roden,1 26 which emphasises that multiple risk factors are needed to overcome the complex and compensatory physiological mechanisms (reserve or redundancy) that interact to maintain a normal ventricular repolarisation. The high prevalence of prescription of TdP risk classified drugs in patients with additional risk factors, in this and other studies,27–31 also suggests that TdP induced by QTc-prolonging drugs is still a neglected issue for many physicians.…”

Prolonged QTc interval in patients of Clinical Medicine: multicenter study

“…En Chile, la frecuencia fue 16% . En Colombia, 10% de la población geriátrica (25) consume fármacos con conocida acción sobre el QTc . En Uruguay, la frecuencia de SQTP fue 9,6% (27) .…”

“…El monitoreo con ECG basal y repetidos durante el uso de ciertos fármacos que pueden prolongar el QTc o en situaciones de riesgo de SQTP está recomendado con el propósito de evitar arritmias graves pues muchos factores (4,6,12) desencadenantes son prevenibles . Esta recomendación es más fuerte ante pacientes ancianos y (15,17,22,25,30).…”

Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

“…Furthermore, their findings cannot be generlised as they targeted patients in geographic area in Jordan. Many previous studies were conducted in the USA (37,38), Colombia (39), Germany (40), and India (41) assessed the patterns of QTcP-inducing drugs prescriptions. Despite that patients with ESRD are at high risk of developing fatal QTcP, none of the recent studies screened for DDIs or prescriptions appropriateness among this patient group particularly.…”