Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

Abstract

Background: Psychiatric patients are at risk of cardiovascular diseases, and many psychotropic drugs can prolong QTc interval. Requirements for electrocardiogram (ECG) monitoring have been set up in our psychiatric university hospital. The objective of this study was to determine the proportion of adult patients who had an ECG during their hospitalization, the prevalence of ECG abnormalities, the evolution of the QTc after admission, and the risk factors for QTc prolongation. Methods: Retrospective analysis of ECGs and clinical data of all patients with a complete hospitalization in 2015. Assessment of the influence of covariates on QTc using linear mixed-effects models. Results: At least one ECG ( n = 600) was performed during 37.6% of the stays ( n = 1198) and in 45.5% of the patients ( n = 871). Among the patients with an ECG, 17.9% had significant ECG abnormalities, including 7.6% with a prolonged QTc. QTc measured at admission and during hospitalization did not change significantly ( n = 46, 419.4 ± 29.7 ms, 417.2 ± 27.6 ms, p = 0.71). In the multivariate model (292 patients, 357 ECGs), the covariates significantly associated with the QTc were gender (+15.9 ms if female, p < 0.0001), age (+0.4 ms/year, p = 0.0001), triglyceride levels (+5.7 ms/mmol/l, p = 0.005), and drugs with known risk of torsades de pointes (+6.2 ms if ⩾1 drug, p = 0.028). Conclusions: The prevalence of hospitalized psychiatric patients with an abnormal ECG indicates that ECGs should be performed systematically in this population. Prescription of psychotropic drugs should be done cautiously, particularly in patients with QTc prolongation risk factors.

Effect of domperidone, ondansetron, olanzapine-containing antiemetic regimen on QTC interval in patients with malignancy: a prospective, observational, single-group, assessor-blinded study

“…Although the antiemetic regimen used in our study may not be the standard practice at other sites, the findings provide clinically significant information regarding the safety of drug combinations with potential QT-prolonging effects. QTc changes with time were significant in females and elderly in our study; this is in agreement with the findings of a retrospective ECG review of hospitalized psychiatry patients on psychotropic drugs 18 . The gender difference is likely to be sex hormone-related 19 whereas the age difference is likely to be due to the effect of ageing on the myocardium and autonomic tone 20 ; interestingly, the latter study showed that in elderly, the QTc prolongation is more severe in males compared with females.…”

A Real-World Study of Risk Factors for QTc Prolongation in Schizophrenia Patients Receiving Atypical Antipsychotics

“…In this study, a higher risk of QTc prolongation was observed in male patients; however, this result is inconsistent with some other studies 17,18 . This inconsistency may be due to the differences in the race of the patients included in the research.…”

“…In this study, a higher risk of QTc prolongation was observed in male patients; however, this result is inconsistent with some other studies. 17,18 This inconsistency may be due to the differences in the race of the patients included in the research. On the other hand, our result confirmed the finding of an epidemiological survey based on a Chinese population, which suggested that men were more likely to have QTc prolongation (QTc > 450 ms for men and QTc > 470 ms for women).…”

Drug-induced torsades de pointes: Disproportionality analysis of the United States Food and Drug Administration adverse event reporting system

“…And these drugs were classified into three categories, “known risk,” “possible risk,” or “conditional risk” of TdP. In our study, comparisons were conducted with the QT drug lists of CredibleMeds ® in an attempt to identify drugs with a potential risk of TdP that are not on the list ( 25 ).…”