Key result
A drug-induced QTc management algorithm for psychiatric patients shows high appropriateness among cardiologists.
Why the study?
Assessing QTc interval prolongation risk is crucial in psychiatric patients exposed to medications that increase life-threatening arrhythmia risk, motivating the validation of an assessment, management, and monitoring algorithm.
Is the proposed algorithm for assessing and managing drug-induced QTc prolongation in psychiatric patients considered valid and appropriate by cardiologists?
Cross-Sectional
Is the proposed algorithm for assessing and managing drug-induced QTc prolongation in psychiatric patients considered valid and appropriate by cardiologists?
An algorithm for managing drug-induced QTc prolongation in psychiatric patients demonstrated high content validity among cardiologists, though simplification was recommended.
Answers are grounded in this paper and cite their sources.
May support algorithm consideration in psychiatric QTc management; leaves open prospective outcome validation.
BACKGROUND: QTc interval (QTcI) prolongation leads to serious complications, making it a concern for clinicians. Assessing the risk of QTcI prolongation in the psychiatric population is important because they are exposed to multiple medications known to increase the risk of life-threatening arrhythmias. AIM: The study aims to validate the content of an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population. METHODOLOGY: Qualitative semi-structured interviews of cardiologists, to gather information regarding their approach in assessing the risk of drug-induced QTc prolongation at the time of prescribing. After the interview, an orientation to the algorithm was provided with a link to a cross-sectional, anonymous survey. The online survey included quantitative and qualitative components to gather feedback on the relevance and appropriateness of each step in the algorithm. RESULTS: Interview responses were incorporated into 4 themes. Responses indicated a lack of a unified protocol when assessing QTcI prolongation, which supports the need of an algorithm that includes a verified risk scoring tool. Quantitative survey results showed a mean score ranging from 3.08 to 3.67 out of 4 for the appropriateness of the algorithm's steps, 3.08 to 3.58 for the safety and 3.17 to 3.75 for the reliability of references used. Additional analysis using the modified kappa and I-CVI statistical measures indicate high validity of contents and high degree of agreement between raters. As per the open-ended questions, cardiologists supported the implementation of the algorithm; however, they recommended simplification of the steps as they appear to be cumbersome. CONCLUSION: The results demonstrate that the implementation of the algorithm after minor alterations can prove to be useful as a tool for the risk assessment of QTc prolongation. Further validation of the algorithm with mental health pharmacists and clinicians will be conducted as a separate phase of the study.
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Zolezzi et al. (2021) conducted a cross-sectional in Drug-induced QTc prolongation in the psychiatric population. Algorithm for the assessment, management and monitoring of drug-induced QTc prolongation was evaluated on Appropriateness, safety, and reliability of the algorithm. An algorithm for managing drug-induced QTc prolongation in psychiatric patients showed high content validity among cardiologists, with mean appropriateness scores of 3.08 to 3.67 out of 4.
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