Key result
Among inpatients receiving a new QT-prolonging drug, those under cardiologists were more likely to have a repeat ECG within 48 hours than those under general physicians (84% vs. 11%, P<0.0001).
Why the study?
Does care under cardiologists compared to general physicians improve the monitoring and recognition of QTc prolongation in inpatients prescribed QT-prolonging medications?
Cohort (n=234)
No
Does care under cardiologists compared to general physicians improve the monitoring and recognition of QTc prolongation in inpatients prescribed QT-prolonging medications?
Absolute Event Rate: 84% vs 11%
p-value: p=<0.0001
Recognition of acquired QTc prolongation in hospitalized patients prescribed QT-prolonging medications is poor across specialties, highlighting a critical need for clinician education and electronic prescribing alerts to prevent arrhythmias.
ECG monitoring after new QT-prolonging drugs varies by specialty; leaves open whether education or alerts standardize care and reduce arrhythmias.
AIMS: This study aimed to assess prescribers' monitoring for arrhythmic risk with QT-prolonging medications (LQT drugs). METHODS: Over a 6-month period, all inpatients under the care of Cardiologists (Cohort A) and General Physicians (Cohort B) at Aberdeen Royal Infirmary who were prescribed drugs with known risk of Torsades de Pointes (TdP) were identified. Admission and repeat electrocardiograms (ECG) after 48 h of commencing a LQT drug were examined. Actions taken if QTc was prolonged and drug-drug interactions were examined. A risk estimate on the UK hospital population was calculated. RESULTS: Of the 4133 patients admitted during the study period, 234 (6%) patients were prescribed a LQT drug. There were 100 (43%) patients in Cohort A and 134 (57%) patients in Cohort B. Of those admitted with a pre-existing LQT drug prescription, an ECG was performed in 167 (96%) of patients and QTc prolongation was identified in 59 (34%). Of those who received a new prescription of LQT drug, 23 (38%) had QTc prolongation and more patients in Cohort A than Cohort B had a repeat ECG within 48 h (84% vs. 11%, P < 0.0001). QTc prolongation was only recognized in 6 (14%) and 2 (5%) patients in cohorts A and B, respectively. Only one patient at risk of drug interaction had QTc prolongation. None of our patients had documented TdP in hospital. Extrapolating these findings to the UK hospital population, at least 204 and <17-175 patients on cardiac and noncardiac LQT drugs, respectively, might be expected to have TdP each year. CONCLUSION: Recognition of acquired QTc prolongation is poor. Clinician education and an electronic prescribing system may improve this situation.
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Choo et al. (2014) conducted a cohort in Inpatients prescribed QT-prolonging medications (n=234). Care by Cardiologists vs. Care by General Physicians was evaluated on Repeat ECG within 48 hours of commencing a new QT-prolonging drug (p=<0.0001). Among inpatients receiving a new QT-prolonging drug, those under cardiologists were more likely to have a repeat ECG within 48 hours than those under general physicians (84% vs. 11%, P<0.0001).
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