The Peter Lamy Center on Drug Therapy and Aging, University of Maryland, College of Pharmacy, West Bloomfield, Michigan.
College of Pharmacy, Purdue University, School of Medicine, Indiana University, Indianapolis, Indiana.
J Am Geriatr Soc. 2019 Jul;67(7):1508-1515. doi: 10.1111/jgs.15810. Epub 2019 Feb 12.
The exponential increase in the number of medications associated with clinically important prolongation of the heart rate-corrected QT interval (QTc) places older adults at increased risk of arrhythmias including life-threatening torsade de pointes (TdP) and sudden death. Risk factors, other than age older than 65 years and female sex, include multiple concurrent drugs that prolong QTc and a variety of underlying predisposing conditions. Although electronic medical records and pharmacy dispensing systems can alert clinicians to the risk of QTc-prolonging therapy, more than 95% of safety alerts are overridden, and many systems have deactivated QTc drug interaction alerts. The clinical consequences, magnitude of the effect, mitigation strategies, and recommended monitoring are not well defined for nursing facility (NF) residents.
Narrative review.
NFs in the United States.
NF residents.
Medications known to prolong QTc include selected anti-infectives, antidepressants, urinary anticholinergics, antipsychotics, and cholinesterase inhibitors (eg, donepezil), used commonly in NFs. Drug-drug interactions are a risk when adding a medication that exaggerates the effect or inhibits the metabolism of a QTc-prolonging medication. The vast majority of patients in whom TdP is induced by noncardiac drugs have risk factors that are easily identifiable.
Recommendations are provided to improve standardization and use of drug interaction alerts, evaluate the risk of QTc-prolonging drugs in older adults receiving generally lower doses, validate a QTc risk score addressing complex multimorbidity, garner evidence to guide clinical decision making, avail NFs of access to electrocardiograms and interpretive recommendations, and develop standards of practice for hosting risk discussions with residents and their families. J Am Geriatr Soc, 1-8, 2019.
与临床重要的心率校正 QT 间期（QTc）延长相关的药物数量呈指数级增长，这使得老年人面临心律失常的风险增加，包括危及生命的尖端扭转型室性心动过速（TdP）和猝死。除年龄大于 65 岁和女性外，其他风险因素还包括多种延长 QTc 的同时使用药物和各种潜在的诱发疾病。尽管电子病历和配药系统可以提醒临床医生注意 QTc 延长治疗的风险，但超过 95%的安全警报被忽略，许多系统已经停用了 QTc 药物相互作用警报。护理院（NF）居民的 QTc 延长治疗的临床后果、影响程度、缓解策略和推荐监测尚未明确。
叙述性综述。
美国的 NF。
NF 居民。
已知延长 QTc 的药物包括一些抗感染药物、抗抑郁药、抗尿潴留的抗胆碱能药物、抗精神病药和胆碱酯酶抑制剂（如多奈哌齐），这些药物在 NF 中常用。当添加一种药物时，药物-药物相互作用会增加药物的作用或抑制 QTc 延长药物的代谢，从而增加风险。绝大多数因非心脏药物引起 TdP 的患者都有易于识别的风险因素。
提供了建议以改善药物相互作用警报的标准化和使用，评估接受通常较低剂量药物的老年人发生 QTc 延长药物的风险，验证一个解决复杂合并症的 QTc 风险评分，收集指导临床决策的证据，使 NF 能够获得心电图和解释性建议，并制定与居民及其家属进行风险讨论的实践标准。J Am Geriatr Soc，2019 年，1-8 页。
