Key result
Among 212,016 critically ill patients, 2.9% received QT-prolonging drugs; coadministration occurred in 18.6% of these patients and was associated with higher ICU mortality and longer stays (p<0.001).
Why the study?
What are the patterns of use and clinical impacts of QT-prolonging drug administration and coadministration in critically ill patients?
Observational (n=212,016)
What are the patterns of use and clinical impacts of QT-prolonging drug administration and coadministration in critically ill patients?
p-value: p=<0.001
While QT-prolonging drugs are used in a minority of critically ill patients, their coadministration is relatively common and associated with increased ICU mortality and length of stay.
QT-prolonging drug coadministration was associated with higher ICU mortality; this observational link leaves open causality and need for prospective trials.
PURPOSE: Commonly prescribed medications produce QT-prolongation and are associated with torsades de pointes in non-acutely ill patients. We examined patterns of QT-prolonging drug use in critically ill individuals. METHODS: An administrative critical care database was utilized to identify patients receiving drugs associated with QT-interval prolongation or torsades de pointes for > or = 24 hours. RESULTS: Data from 212 016 individuals collected over a 63-month period was examined to identify 6125 patients (2.9%) receiving QT-interval prolonging drugs. These individuals had a mean (+/-SE) age of 63.0 (+/-0.2) years, were predominately male (55.4%) and Caucasian (84.4%), and were exposed to QT-interval prolonging agents for a mean (+/-SE) 53.1 (+/-0.4)% of their ICU length of stay. Respiratory and cardiovascular illnesses were the most common reasons for ICU admission (17.2, 12.0%, respectively). The most frequently administered agents were amiodarone (23.5%), haloperidol (19.8%), and levofloxacin (19.7%); no other single agent accounted for more than 10% of QT-interval prolonging drugs prescribed. Coadministration of QT-prolonging drugs occurred in 1139 patients (18.6%). These patients had higher ICU mortality rate and longer ICU lengths of stay, compared to patients not receiving coadministered drugs (p < 0.001 for both). For patients receiving coadministered drugs, overlap occurred for 71.4 (+/-0.8)% of the time that the drugs were given. Amiodarone coadministration with antibiotics, haloperidol coadministration with antibiotics, and haloperidol coadministration with amiodarone, comprised 15.2, 13.7, and 9.4%, of all coadministered agents, respectively. CONCLUSIONS: QT-prolonging drugs were used in a minority of critically ill patients. Prospective evaluation in the ICU environment is necessary to determine whether administration of these agents is associated with adverse cardiac events comparable to those reported in ambulatory patients.
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Freeman et al. (2008) conducted an observational in Critically ill patients (n=212,016). QT-interval prolonging drugs vs. Patients not receiving coadministered QT-prolonging drugs was evaluated on ICU mortality and ICU length of stay associated with coadministration of QT-prolonging drugs (p=<0.001). Among 212,016 critically ill patients, 2.9% received QT-prolonging drugs; coadministration occurred in 18.6% of these patients and was associated with higher ICU mortality and longer stays (p<0.001).
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