Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

Ali, Zahid; Ismail, Mohammad; Nazar, Zahid; Khan, Fahadullah; Khan, Qudrat; Noor, Sidra

doi:10.1186/s12888-020-02687-w

Cited by 17 publications

(15 citation statements)

References 44 publications

(54 reference statements)

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“…The most frequently prescribed drugs with a known risk for QT c prolongation in our study were haloperidol and citalopram. In previous studies in the psychiatric setting, these drugs were also among the most frequently prescribed substances in this category, along with levomepromazine and chlorpromazine (26,32,34). Pipamperone and mirtazapine were the most common drugs with a conditional risk in our study, whereas in other investigations these two drugs were prescribed infrequently, in contrast to lithium and aripiprazole, which were leaders in this category in previous reports (26,32,34).…”

Section: Discussionmentioning

confidence: 82%

“…In previous studies in the psychiatric setting, these drugs were also among the most frequently prescribed substances in this category, along with levomepromazine and chlorpromazine (26,32,34). Pipamperone and mirtazapine were the most common drugs with a conditional risk in our study, whereas in other investigations these two drugs were prescribed infrequently, in contrast to lithium and aripiprazole, which were leaders in this category in previous reports (26,32,34). Moreover, the most frequently prescribed QT c -prolonging drugs in our study were pantoprazole and risperidone, both of which convey a possible risk of QT c prolongation according to the AzCERT classification.…”

Section: Discussionmentioning

confidence: 82%

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Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

et al. 2023

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IntroductionQTc prolongation carries the risk of ventricular tachyarrhythmia (Torsades de Pointes) and sudden cardiac death. Psychotropic drugs can affect ventricular repolarization and thus prolong the QTc interval. The present study sought to investigate the risk factors (pharmacological and non-pharmacological) of severe QTc prolongation in gerontopsychiatric patients.MethodsElectrocardiograms of patients on a gerontopsychiatric ward were screened for QTc prolongation. Medication lists were examined utilizing the AzCERT classification. Potential drug interactions were identified with the electronic drug interaction program mediQ.ResultsThe overall prevalence of QTc prolongation was 13.6%, with 1.9% displaying severe QTc prolongation (≥ 500 ms). No statistically significant differences between patients with moderate and severe QTc prolongation were identified; however, patients with severe QTc prolongation tended to take more drugs (p = 0.063). 92.7% of patients with QTc prolongation took at least one AzCERT-listed drug, most frequently risperidone and pantoprazole. Risperidone and pantoprazole, along with pipamperone, were also most frequently involved in potential drug interactions. All patients displayed additional risk factors for QTc prolongation, particularly cardiac diseases.ConclusionIn addition to the use of potentially QTc-prolonging drugs, other risk factors, especially cardiac diseases, appear to be relevant for the development of QTc prolongation in gerontopsychiatric patients. Pantoprazole was frequently involved in potential drug interactions and should generally not be used for more than 8 weeks in geriatric populations. As clinical consequences of QTc prolongation were rare, potentially QTc-prolonging drugs should not be used overcautiously; their therapeutic benefit should be considered as well. It is paramount to perform diligent benefit–risk analyses prior to the initiation of potentially QTc-prolonging drugs and to closely monitor their clinical (side) effects.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 82%

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

et al. 2023

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“…Low or inadequate use of ECG monitoring in relation to the prevention of drug-induced QT prolongation has been widely acknowledged and reported [4,10,32,[34][35][36][37][38]. This is the first systematic review to summarise the prevalence of ECG use for high-risk QT interval prolonging medicines in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Use of Electrocardiogram Monitoring in Adult Patients Taking High-Risk QT Interval Prolonging Medicines in Clinical Practice: Systematic Review and Meta-analysis

et al. 2022

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Introduction Electrocardiogram (ECG) monitoring is an important tool to detect and mitigate the risk of potentially fatal drug-induced QT prolongation and remains fundamental in supporting the quality use of high-risk QT interval prolonging medicines.Objective The aim of this systematic review was to determine the prevalence of baseline and/or follow-up ECG use in adult patients taking high-risk QT interval prolonging medicines in clinical practice. Methods CINAHL, Cochrane Library, Embase, PubMed, EThOS, OpenGrey and Proquest were searched for studies in adults that reported ECG use at baseline and/or at follow-up in relation to the initiation of a high-risk QT interval prolonging medicine in any clinical setting; either hospital or non-hospital. Two reviewers independently assessed the methodological quality of included studies. Proportional meta-analysis was conducted with all studies reporting baseline ECG use, before medicine initiation, and follow-up ECG use, within 30 days of medicine initiation. Results There was variability in baseline ECG use according to the practice setting. The prevalence of baseline ECG use for high-risk QT interval prolonging medicines was moderate to high in the hospital setting at 75.1% (95% CI 64.3-84.5); however, the prevalence of baseline ECG use was low in the non-hospital setting at 33.7% (95% CI 25.8-42.2). The prevalence of follow-up ECG use was low to moderate in the hospital setting at 39.2% (95% CI 28.2-50.8) and could not be determined for the non-hospital setting. Conclusions The use of ECG monitoring for high-risk QT interval prolonging medicines is strongly influenced by the clinical practice setting. Baseline ECG use occurs more in the hospital setting in comparison to the non-hospital setting. There is lower use of follow-up ECG in comparison to baseline ECG.

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“…APs and have the potential to result in arrhythmias 5 . TdP has been associated with the occurrence of delayed repolarization with early afterdepolarization (EAD), delayed afterdepolarization (DAD), and functional re-entry in the setting of unidirectional conduction block and increased transmural dispersion of repolarization ([TDR], a measure of the intrinsic electrical heterogeneity of the ventricular myocardium) [7][8][9][10][11][12][13] .…”

Section: Quantitative or Qualitative Defects In Ion Channels Lead To mentioning

confidence: 99%

Long QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should Know

Niimi

Yuki

Zaleski

2022

Journal of Cardiothoracic and Vascular Anesthesia

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Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study

Cited by 17 publications

References 44 publications

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

Use of Electrocardiogram Monitoring in Adult Patients Taking High-Risk QT Interval Prolonging Medicines in Clinical Practice: Systematic Review and Meta-analysis

Long QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should Know

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