Out‐of‐hospital cardiac arrest and differential risk of cardiac and non‐cardiac QT‐prolonging drugs in 37 000 cases

Abstract

Numbers of figures: 3What is already known about this subject:  Drugs that prolong the QT interval, either by design (cardiac QT-prolonging drugs: anti-arrhythmics) or as off-target effect (non-cardiac QT-prolonging drugs), may increase the risk of ventricular arrhythmias and out-of-hospital cardiac arrest (OHCA). Education efforts have been invested to increase the awareness of this risk among cardiologists (in training), and to train them to take risk-mitigating actions. Whether this has resulted in risk reduction in the general population in current clinical practice is unknown What this study adds: Cardiac QT-prolonging drugs confer a lower OHCA-risk than non-cardiac QTprolonging drugs, although users of cardiac QT-prolonging drugs have a higher comorbidity burden than users of non-cardiac QT-prolonging drugs. This is likely due to risk mitigation measures surrounding prescription of cardiac QTprolonging drugs.

Sudden cardiac arrest in patients with schizophrenia: A population-based study of resuscitation outcomes and pre-existing cardiovascular disease

“…Other medications may also play a role: among cases with schizophrenia, one-third were also taking antidepressants, which have also been associated with non-shockable rhythms in some studies [29] . Evidence from the Netherlands and Denmark suggests that use of non-cardiac QT prolonging drugs may have a higher risk of out of hospital SCA compared to cardiac QT prolonging drugs [33] . Finally, polypharmacy was more prevalent among schizophrenia cases than comparison cases, which may increase risk of SCA via QT-prolongation or other mechanisms.…”

Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest: a nationwide study

“…to drugs prescribed to treat non-cardiac disease. [4][5][6][7][8] The latter is important considering that non-cardiac drugs consist of many widely used drugs in the clinical setting (eg, antipsychotics, antibiotics [4][5][6][7][8] ) which are likely to be prescribed by non-cardiologists who may not be aware of the possible OHCA risk and/or have less means to monitor this risk. 5 Fluoroquinolones (FQs) are a class of widely used antibiotics with broad-spectrum activity against both grampositive and gram-negative bacteria.…”

“… 4–8 The latter is important considering that non-cardiac drugs consist of many widely used drugs in the clinical setting (eg, antipsychotics, antibiotics 4–8 ) which are likely to be prescribed by non-cardiologists who may not be aware of the possible OHCA risk and/or have less means to monitor this risk. 5 …”

A biosensing system using a multiparameter nonlinear dynamic analysis of cardiomyocyte beating for drug-induced arrhythmia recognition

“…Serious arrhythmias can lead to less effectiveness in heart pumps and may result in loss of heart function in sudden cardiac death (SCD), which can cause 17.9 million deaths worldwide every year 4 , 5 . Drugs treating noncardiac diseases can also cause cardiac arrhythmias in a number of clinical situations 6 – 8 . Considering the high mortality of SCD, cardiac arrhythmias caused by drugs have become one of the most crucial adverse effects to be assessed in novel drug development and postmarketing drug surveillance 9 – 11 .…”