Navigating the pharmacologic complexities of QTc prolongation: assessing the cumulative burden in individuals with serious mental illness

Abstract

The scientific progress made in the pharmacologic management of serious mental illness (SMI) has been significant. However, the benefits of medication management must continually be weighed against the risks of adverse effects of the agents prescribed. While many medications pose increased danger of QTc prolongation, which may result in malignant arrhythmia and sudden cardiac death, the combination of medications contributing QTc risk can result in an impact of unpredictable pharmacodynamic magnitude. Pharmacists play a key role in communicating QTc risks to prescribers, however little if any clinical guidance informs clinicians of specific actions to take when initiating or continuing a clinically necessary combination that poses risk. This study is a cross-sectional view of Med Safety Scan (MSS) QT prolongation risk scores, generated from the ranking tool available from the CredibleMeds website, intended to provide greater understanding of overall risk of QT burden to assist in the prescribing of medications to patients with SMI in a psychiatric hospital.

The interplay of psychopharmacology and medical conditions

“…However, there is still little evidence of the application of these scoring systems in real clinical practice. The paper by Lee Demler in this issue (Demler and O'Donnell, 2023) tested the comprehensive Med Safety Scan QT prolongation risk score in a sample of inpatients, to understand its potential utility and implications. The results demonstrated the usefulness of scoring the patient's individual risk by combining information that may not be part of routine assessment, which may be missed in routine clinical care.…”