White Samara, Demler Tammie Lee, Trigoboff Eileen
Drs. White and Demler are with The New York State Office of Mental Health at Buffalo Psychiatric Center in Buffalo, New York.
Drs. Demler and Trigoboff are with the State University of New York at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice in Buffalo, New York, and the State University of New York at Buffalo School of Medicine, Department of Psychiatry in Buffalo, New York.
Innov Clin Neurosci. 2025 Jun 1;22(4-6):14-19. eCollection 2025 Apr-Jun.
Psychiatric inpatients often require complex medication regimens due to the refractory nature of their serious mental illness (SMI) and the high prevalence of medical comorbidities. Among the many inherent issues associated with these regimens are the potential pharmacodynamic drug interactions resulting in an increased risk of QTc prolongation and the potential sequelae, Torsades de Pointes (TdP). This study builds on previous research that demonstrated the utility of the MedSafety Scan (MSS) clinical decision support (CDS) tool by establishing theoretical evidence from patients with SMI but did not provide objective data to validate its use in this population. This has left prescribers questioning whether the MSS CDS tool is capable of accurately guiding prescribing decisions in this vulnerable patient population. Therefore, the objective of this study was to assess the degree of correlation between psychiatric patients' QTc intervals and their MSS-calculated TdP risk scores to objectively validate the predictive impact and clinical value of the MSS tool in psychiatric inpatients for the purpose of informing safe prescribing.
A retrospective analysis was conducted to assess the relationship between participants' MSS TdP risk scores and their QTc Δ, defined as the difference between participants' measured QTc intervals and sex-specific QTc prolongation thresholds (female individuals: 470ms; male individuals: 450ms). The MSS TdP risk score is calculated based on patient demographic data, medical diagnoses, serum electrolyte values, and medications. Data from 251 subjects were extracted from an adult inpatient psychiatric facility's electronic medical record system from February 1, 2018, through November 30, 2023. Inpatients with a documented electrocardiogram during the study period were eligible for inclusion, and the exclusion criterion was having a Criminal Procedure Law (CPL) designation. Data were analyzed using a one-way analysis of variance (ANOVA) with alpha set to 0.01.
The data from the ANOVA that compared participants' QTc Δ to MSS TdP risk score were found to be significant (<0.01).
This study showed that the MSS CDS tool accurately reflected the relationship between our psychiatric inpatients' measured QTc intervals and their predicted MSS TdP risk scores, which objectively validated the predictive impact and clinical utility of this tool in our psychiatric population. Prescribers can use this tool to mitigate QTc prolongation risk for patients without underlying, unknown congenital risk; therefore, this can be an important course of action in treating psychiatric patients, given their predisposition to decreased lifespans and their increased risk of QTc prolongation due to SMI-related proarrhythmic factors. The MSS tool is an open-source, web-based CDS tool that provides comprehensive analyses of TdP risk, drug interactions, and duplicate therapies, and produces a detailed patient-specific report that allows for documentation of management plans. These features prove MSS to be a valuable tool for psychiatric inpatient clinicians to establish an initial basic clinical impression to advise need for additional comprehensive medical follow-up, cardiology consultation, or pharmacotherapeutic modifications.
由于严重精神疾病（SMI）的难治性以及医疗合并症的高患病率，精神科住院患者通常需要复杂的药物治疗方案。这些治疗方案存在许多内在问题，其中包括潜在的药效学药物相互作用，这会增加QTc延长的风险以及潜在的后遗症尖端扭转型室速（TdP）。本研究基于先前的研究，该研究通过从SMI患者中建立理论证据证明了MedSafety Scan（MSS）临床决策支持（CDS）工具的效用，但未提供客观数据来验证其在该人群中的使用。这使得开处方者质疑MSS CDS工具是否能够准确指导这一脆弱患者群体的处方决策。因此，本研究的目的是评估精神科患者的QTc间期与其MSS计算的TdP风险评分之间的相关程度，以客观验证MSS工具在精神科住院患者中的预测影响和临床价值，为安全处方提供依据。
进行回顾性分析，以评估参与者的MSS TdP风险评分与其QTc Δ之间的关系，QTc Δ定义为参与者测量的QTc间期与性别特异性QTc延长阈值（女性：470ms；男性：450ms）之间的差异。MSS TdP风险评分是根据患者人口统计学数据、医学诊断、血清电解质值和药物计算得出的。从2018年2月1日至2023年11月30日，从一家成人住院精神科机构的电子病历系统中提取了251名受试者的数据。研究期间有心电图记录的住院患者符合纳入标准，排除标准是具有《刑事诉讼法》（CPL）指定。使用单因素方差分析（ANOVA）进行数据分析，α设定为0.01。
将参与者的QTc Δ与MSS TdP风险评分进行比较的方差分析数据具有显著性（<0.01）。
本研究表明，MSS CDS工具准确反映了我们精神科住院患者测量的QTc间期与其预测的MSS TdP风险评分之间的关系，这客观验证了该工具在我们精神科人群中的预测影响和临床效用。开处方者可以使用该工具来降低无潜在未知先天性风险患者QTc延长的风险；因此，鉴于精神科患者由于SMI相关的促心律失常因素而寿命缩短的倾向以及QTc延长风险增加，这可能是治疗精神科患者的重要行动方案。MSS工具是一个基于网络的开源CDS工具，可对TdP风险、药物相互作用和重复治疗进行全面分析，并生成详细的患者特定报告，允许记录管理计划。这些特性证明MSS是精神科住院临床医生建立初步基本临床印象以建议是否需要额外的全面医学随访、心脏病学咨询或药物治疗调整的有价值工具。
