Franchi C, Ardoino I, Rossio R, Nobili A, Biganzoli E M, Marengoni A, Marcucci M, Pasina L, Tettamanti M, Corrao S, Mannucci P M
Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Drugs Aging. 2016 Jan;33(1):53-61. doi: 10.1007/s40266-015-0337-y.
The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older).
Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed.
Among 3906 patients prescribed at least one drug at admission, 2156 (55.2%) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95% CI 1.01-1.03), multimorbidity (OR 2.69, 95% CI 2.33-3.10), hypokalemia (OR 2.79, 95% CI 1.32-5.89), atrial fibrillation (OR 1.66, 95% CI 1.40-1.98), and heart failure (OR 3.17, 95% CI 2.49-4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8% were prescribed them at discharge.
Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.
本研究的目的是评估住院时和出院时开具延长QT间期药物的情况，以及老年人（65岁及以上）使用这些药物的相关危险因素。
数据来自REPOSI（意大利内科医学学会药物治疗登记）登记处，该登记处分别在2008年（n = 1332）、2010年（n = 1380）和2012年（n = 1323）纳入了4035名患者。进行多变量逻辑回归以确定与使用延长QT间期药物独立相关的危险因素。根据亚利桑那治疗教育与研究中心（AzCERT）的分类，将延长QT间期药物按尖端扭转型室速（TdP）风险（明确、可能或条件性）进行分类。还评估了特定的药物组合。
在3906名入院时至少开具了一种药物的患者中，2156名（55.2%）正在服用至少一种延长QT间期的药物。与使用任何延长QT间期药物独立相关的危险因素包括年龄增加（比值比[OR] 1.02，95%置信区间1.01 - 1.03）、多种疾病（OR 2.69，95%置信区间2.33 - 3.10）、低钾血症（OR 2.79，95%置信区间1.32 - 5.89）、心房颤动（OR 1.66，95%置信区间1.40 - 1.98）和心力衰竭（OR 3.17，95%置信区间2.49 - 4.05）。呋塞米单独或联合使用是最常开具的药物。胺碘酮是开具最多且有明确TdP风险的药物。出院时，延长QT间期药物的绝对数量（2890对3549）和接受这些药物治疗的患者数量（2456对2156）均增加。在1808名入院时未开具延长QT间期药物的患者中，35.8%在出院时开具了此类药物。
尽管存在风险，但延长QT间期药物在住院老年人中仍被广泛开具。应加强执业医师和医学生的课程设置，以提供更多关于药物合理使用的教育，从而改善对住院老年人的管理。
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