Abstract
QT interval prolongation is associated with torsade de pointes and sudden cardiac death. QT prolongation can be caused by many drugs that are commonly prescribed in elderly residential aged care populations. The aim of this study was to investigate the prevalence of use of QT-prolonging drugs and to identify interventions made by pharmacists to reduce the risk of QT prolongation when conducting medication reviews in aged care. A retrospective analysis of 400 medication reviews undertaken by Australian pharmacists in aged care settings was conducted. The assessment included the risk of QT prolongation due to prescribed medications and other risk factors and the recommendations made by pharmacists to reduce the risk of QT prolongation. There was a high prevalence of the use of QT-prolonging medication, with 23% of residents (92 out of 400) taking at least one medication with a known risk of QT prolongation. Amongst the 945 prescribed drugs with any risk of QT prolongation, antipsychotics were the most common (n = 246, 26%), followed by antidepressants (19%) and proton pump inhibitors (13%). There appeared to be low awareness amongst the pharmacists regarding the risk of QT prolongation with drugs. Out of 400 reviews, 66 residents were categorised as high risk and were taking at least one medication associated with QT prolongation; yet pharmacists intervened in only six instances (9%), mostly when two QT-prolonging medications were prescribed. There is a need to increase awareness amongst pharmacists conducting medication reviews regarding the risk factors associated with QT prolongation, and further education is generally needed in this area.
Highlights
The QT interval is defined as the time between the onset of the QRS complex and the offset of the T wave, as seen on the surface electrocardiogram (ECG), and represents ventricular depolarisation and repolarisation, i.e., the time between contraction and relaxation of the heart muscle [1]
torsade de pointes (TdP) is a rare polymorphic ventricular arrhythmia that typically occurs in self-limiting bursts leading to symptoms of dizziness, palpitations, syncope, and seizures, but can occasionally progress to ventricular fibrillation and sudden cardiac death [3]
Many medications commonly prescribed in residential aged care populations may prolong the QT interval directly or indirectly
Summary
The QT interval is defined as the time between the onset of the QRS complex and the offset of the T wave, as seen on the surface electrocardiogram (ECG), and represents ventricular depolarisation and repolarisation, i.e., the time between contraction and relaxation of the heart muscle [1]. QT interval (>450 msec for males and >470 msec for females) is associated with an increased risk of ventricular arrhythmias, including the potentially lethal torsade de pointes (TdP) [2]. The electrocardiographic waveform of TdP is characterised by rapid irregular QRS complexes that appear to twist around the isoelectric baseline. It can result from having inherited long QT syndrome (LQTS) or acquired conditions such as drug-induced QT prolongation [4]. Many medications commonly prescribed in residential aged care populations may prolong the QT interval directly or indirectly. These include antipsychotics, antidepressants, and medications for cardiac conditions [6]
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