Choo Wai Kah, Turpie David, Milne Kim, Davidson Lynne, Elofuke Petrus, Whitfield Jonathan, Broadhurst Paul
Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK.
Cardiovasc Ther. 2014 Oct;32(5):209-13. doi: 10.1111/1755-5922.12085.
This study aimed to assess prescribers' monitoring for arrhythmic risk with QT-prolonging medications (LQT drugs).
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.
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.
Recognition of acquired QTc prolongation is poor. Clinician education and an electronic prescribing system may improve this situation.
本研究旨在评估处方医生对使用可延长QT间期的药物（长QT药物，LQT药物）时心律失常风险的监测情况。
在6个月的时间里，确定了阿伯丁皇家医院心内科医生负责治疗的所有住院患者（A组）和普通内科医生负责治疗的所有住院患者（B组）中，那些被开具已知有尖端扭转型室性心动过速（TdP）风险药物的患者。检查开始使用LQT药物48小时后的入院心电图和复查心电图。研究了如果QTc延长采取的措施以及药物相互作用情况。计算了英国医院人群的风险估计值。
在研究期间入院的4133例患者中，234例（6%）患者被开具了LQT药物。A组有100例（43%）患者，B组有134例（57%）患者。在那些入院时已有LQT药物处方的患者中，167例（96%）患者进行了心电图检查，其中59例（34%）患者被确定QTc延长。在那些接受新LQT药物处方的患者中，23例（38%）患者QTc延长，A组比B组更多患者在48小时内进行了复查心电图（84%对11%，P<0.0001）。A组和B组分别只有6例（14%）和2例（5%）患者的QTc延长被识别出来。只有1例有药物相互作用风险的患者出现QTc延长。我们的患者在医院均无记录到TdP。将这些结果外推至英国医院人群，预计每年使用心脏和非心脏LQT药物的患者中分别至少有204例和17 - 175例可能发生TdP。
对获得性QTc延长的识别较差。临床医生教育和电子处方系统可能会改善这种情况。
