July 21, 2006British Journal of Clinical PharmacologyOpen Access

In‐hospital cardiac arrest is associated with use of non‐antiarrhythmic QTc‐prolonging drugs

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: In-hospital cardiac arrest (n=700). Intervention: Non-antiarrhythmic QTc-prolonging drugs vs. Non-use of non-antiarrhythmic QTc-prolonging drugs. Primary outcome: In-hospital cardiac arrest (OR 2.1, 95% CI 1.2-3.5).

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Key result

Current use of non-antiarrhythmic QTc-prolonging drugs in hospitalized patients is associated with a significantly increased risk of cardiac arrest (adjusted OR 2.1).

Why the study?

Does the use of non-antiarrhythmic QTc-prolonging drugs increase the risk of cardiac arrest in hospitalized patients?

Population

Hospitalized patients for whom intervention of the advanced life support resuscitation team was requested…

Comparison

Current use of non-antiarrhythmic QTc-prolonging… vs Controls not using non-antiarrhythmic…

Design

Case-control

Authors

MBMarie L. De BruinUniversity of Copenhagen PLPim N.J. LangendijkReinier de Graaf Hospital RKRichard P. KoopmansLeiden University

Discussion

Member takes

Implication

May warrant ECG monitoring in hospitalized patients on these agents; leaves open causality in prospective studies.

Study Design

Type

Case-Control (n=700)

Multicenter

Structured PICO

Does the use of non-antiarrhythmic QTc-prolonging drugs increase the risk of cardiac arrest in hospitalized patients?

Population

700 hospitalized patients (140 cases of cardiac arrest and 560 matched controls) evaluated to quantify the risk of cardiac arrest associated with the use of non-antiarrhythmic QTc-prolonging drugs.

Exposure

Current use of non-antiarrhythmic QTc-prolonging drugs

Comparator

Controls not using non-antiarrhythmic QTc-prolonging drugs

Outcome

Cardiac arrest requiring advanced life support resuscitationhard clinical

Main Result

Odds Ratio: 2.1 (95% CI 1.2–3.5)

The use of non-antiarrhythmic QTc-prolonging drugs in hospitalized patients is associated with a dose-dependent increased risk of cardiac arrest, which is further exacerbated by drug-drug interactions.

Limitations

Potential misclassification of outcome due to control patients with do-not-attempt-resuscitation orders who may have experienced cardiac arrest.
Potential misclassification of exposure.
Inability to fully control for disease severity (e.g., lack of APACHE II score adjustment).
Confounding by contraindication, as doctors may refrain from prescribing QTc-prolonging drugs to high-risk patients.
Observational design can only indicate associations, not causal relationships.

Cite This Study

Bruin et al. (2006) conducted a case-control in In-hospital cardiac arrest (n=700). Non-antiarrhythmic QTc-prolonging drugs vs. Non-use of non-antiarrhythmic QTc-prolonging drugs was evaluated on In-hospital cardiac arrest (OR 2.1, 95% CI 1.2-3.5). Current use of non-antiarrhythmic QTc-prolonging drugs in hospitalized patients is associated with a significantly increased risk of cardiac arrest (adjusted OR 2.1).

synapsesocial.com/papers/6a977fb3713b4e110fe3319d https://doi.org/10.1111/j.1365-2125.2006.02722.x

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In‐hospital cardiac arrest is associated with use of non‐antiarrhythmic QTc‐prolonging drugs

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

In‐hospital cardiac arrest is associated with use of non‐antiarrhythmic QTc‐prolonging drugs

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider