What does this research mean for the field?

Drug-regimen-identified risk of QT prolongation does not correlate with manifest QT prolongation in psychiatric inpatients, whereas advanced age and cardiovascular comorbidity are significant predictors. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate whether drug-regimen-identified risk manifests as clinical QT prolongation (QTc > 480 ms) in psychiatric inpatients and to evaluate the predictive power of pharmacological versus non-pharmacological risk factors.

October 16, 2024PharmaceuticalsOpen Access

Assessing the Risk of QT Prolongation in a Psychiatric Inpatient Cohort: A Retrospective Cross-Sectional Study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Psychiatric inpatients at risk of QT prolongation (n=799). Intervention: Identified risk of drug-induced QT prolongation vs. No identified risk of drug-induced QT prolongation. Primary outcome: Manifest QT prolongation (QTc value > 480 ms).

View Full Paper

Ask AI

Bookmark

Key result

Drug-induced QT risk fails to predict manifest QT prolongation in psychiatric inpatients.

n=799

Why the study?

Assessing the risk of QT-prolonging drugs is routinely performed in psychotropic medication reviews, but the actual clinical benefits of these assessments are unknown.

Does an identified risk of QT prolongation by drug reviews predict manifest QT prolongation in psychiatric inpatients?

Population

799 psychiatric inpatients exposed to pharmacist-led-medication reviews in Region Zealand Denmark

Comparison

Patients with vs without increased risk of QT prolongation identified by medication reviews

Design

Retrospective cross-sectional study

Authors

JCJohan Frederik Mebus Meyer ChristensenUniversity of Copenhagen JJJonathan Hugo Jürgens‐LahnsteinAarhus University AIAfrim IljaziUniversity of Copenhagen

Discussion

Member takes

Implication

Drug review-identified QT risk may not predict actual prolongation in psychiatric inpatients; leaves open whether age and cardiovascular comorbidity should guide ECG monitoring.

Key Points

To investigate whether drug-regimen-identified risk manifests as clinical QT prolongation (QTc > 480 ms) in psychiatric inpatients and to evaluate the predictive power of pharmacological versus non-pharmacological risk factors.
Retrospective cross-sectional review of electronic health records from 799 psychiatric inpatients undergoing pharmacist-led medication reviews (PMRs) between 1 September 2016 and 31 December 2018 across three psychiatric hospitals in Region Zealand, Denmark.
Extracted 290 electrocardiograms (ECGs) from patients identified with increased risk of drug-induced QT prolongation and 190 ECGs from patients with no such risk, evaluating manifest QT prolongation defined as QTc > 480 ms.
Identified 33 cases of verified QT prolongation, with no statistical difference in distribution between the QT+ risk group (n=19) and the QT÷ risk group (n=14).
Unadjusted regression analysis revealed that advanced age (OR 3.27, 95% CI 1.60-6.84) and cardiovascular comorbidity (OR 3.53, 95% CI 1.71-7.29) were significantly associated with manifest QT prolongation, whereas cumulative QT-prolonging drug load was not.

Study Design

Type

Cross-Sectional (n=799)

Multicenter

Yes

Structured PICO

Does an identified risk of QT prolongation by drug reviews predict manifest QT prolongation in psychiatric inpatients?

Population

799 psychiatric inpatients who underwent pharmacist-led medication reviews were retrospectively analyzed to determine if an identified risk of drug-induced QT prolongation manifests as actual QT prolongation.

Exposure

Pharmacist-led medication reviews identifying an increased risk of drug-induced QT prolongation (QT+ risk group)

Comparator

Patients with no identified risk of drug-induced QT prolongation (QT- risk group)

Outcome

Manifest QT prolongation (QTc value > 480 ms)surrogate

Main Result

Absolute Event Rate: 19% vs 14%

Non-pharmacological risk factors such as advanced age and cardiovascular comorbidity are stronger predictors of QT prolongation than the cumulative load of QT-prolonging drugs in psychiatric inpatients.

Limitations

Missing clinical data for some patients, including ECGs available for only 480 of the 799 patients.
Insufficient data on inflammatory biomarkers and substance abuse to adjust for these factors in the analyses.
Lack of longitudinal data to assess the potential preventive effect of medication reviews on future instances of QT prolongation.
The study cohort was limited to psychiatric inpatients from a single region in Denmark, which may reduce the generalizability of the results.
Missing clinical data, including inflammatory biomarkers and detailed substance abuse information
Missing information on 220 of 799 patients
Potential confounding by indication as physicians may have optimized pharmacological treatment prior to PMRs
Lack of longitudinal data to assess the preventive effect of PMRs
Single region cohort limits generalizability

Cite This Study

Christensen et al. (2024) conducted a cross-sectional in Psychiatric inpatients at risk of QT prolongation (n=799). Identified risk of drug-induced QT prolongation vs. No identified risk of drug-induced QT prolongation was evaluated on Manifest QT prolongation (QTc value > 480 ms). An identified risk of drug-induced QT prolongation was not associated with actual QT prolongation in psychiatric inpatients, whereas non-pharmacological factors like advanced age (OR 3.27) and cardiovascular comorbidity (OR 3.53) were significant predictors.

synapsesocial.com/papers/6a17a609d990e918e6b454fb https://doi.org/10.3390/ph17101373

View Full Paper

Ask AI

Bookmark

Implication

Drug review-identified QT risk may not predict actual prolongation in psychiatric inpatients; leaves open whether age and cardiovascular comorbidity should guide ECG monitoring.