Prevalence of QT Interval Prolongation in Patients Admitted to Cardiac Care Units and Frequency of Subsequent Administra
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Drug Saf 2012; 35 (6): 459-470 0114-5916/12/0006-0459/$49.95/0 Adis ª 2012 Springer International Publishing AG. All rights reserved.
Prevalence of QT Interval Prolongation in Patients Admitted to Cardiac Care Units and Frequency of Subsequent Administration of QT Interval-Prolonging Drugs A Prospective, Observational Study in a Large Urban Academic Medical Center in the US James E. Tisdale,1,2 Heather A. Wroblewski,1 Brian R. Overholser,1,2 Joanna R. Kingery,3 Tate N. Trujillo3 and Richard J. Kovacs4 1 2 3 4
College of Pharmacy, Purdue University, Indianapolis, IN, USA Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA Department of Pharmacy, Indiana University Health Methodist Hospital, Indianapolis, IN, USA Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, IN, USA
Abstract
Background: Cardiac arrest due to torsades de pointes (TdP) is a rare but catastrophic event in hospitals. Patients admitted to cardiac units are at higher risk of drug-induced QT interval prolongation and TdP, due to a preponderance of risk factors. Few data exist regarding the prevalence of QT interval prolongation in patients admitted to cardiac units or the frequency of administering QT interval-prolonging drugs to patients presenting with QT interval prolongation. Objective: The aim of this study was to determine the prevalence of Bazett’scorrected QT (QTc) interval prolongation upon admission to cardiac units and the proportion of patients presenting with QTc interval prolongation who are subsequently administered QT interval-prolonging drugs during hospitalization. Methods: This was a prospective, observational study conducted over a 1-year period (October 2008–October 2009) in 1159 consecutive patients admitted to two cardiac units in a large urban academic medical centre located in Indianapolis, IN, USA. Patients were enrolled into the study at the time of admission to the hospital and were followed daily during hospitalization. Exclusion criteria were age 500 ms. Of 251 patients admitted with QTc interval prolongation, 87 (34.7%) were subsequently administered QT interval-prolonging drugs. Of 166 patients admitted with QTc interval >500 ms, 70 (42.2%) were subsequently administered QT intervalprolonging drugs; additional QTc interval prolongation ‡60 ms occurred in 57.1% of these patients. Conclusions: QTc interval prolongation is common among patients admitted to cardiac units. QT interval-prolonging drugs are commonly prescribed to patients presenting with QTc interval prolongation.
Torsades de pointes (TdP) is a potentially lifethreatening polymorphic ventricular tachycardia associated with prolongation of the QT interval.[1,2] More than 50 drugs on the US market, from a variety of drug classes, have the potential to cause TdP.[3] Cardiac arrest due to TdP is an uncommon but catastrophic event in hospitalized patients.[4] The risk of drug-induced TdP may be greater in hospitalized patients than in outpatient populations, because hospitalized patients are
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