Abstract
BackgroundQT interval prolongation is a growing concern worldwide, posing psychiatric patients to life-threatening fatal arrhythmias i.e., torsade de pointes. This study aimed to identify the prevalence of QT interval prolongation, its associated risk factors and prescribing patterns of QT prolonging drugs among psychiatric patients.MethodA prospective observational study was conducted that included psychiatric patients from a tertiary care hospital and a psychiatry clinic in Peshawar, Khyber Pakhtunkhwa, Pakistan. Electrocardiogram was recorded of those patients who were using psychotropic medications for ≥7 days, aged 18 years or more, and of either gender, male or female. The Fredericia correction formula was used for measuring QTc values (corrected QT). Chi-square test was applied to estimate differences between patients with or without prolonged QTc interval whereas, logistic regression analysis was performed to identify various predictors of QT interval prolongation.ResultsOut of 405 patients, the QTc interval was prolonged in 23 (5.7%) patients including 1 (0.2%) patient with highly abnormal prolonged QTc interval (> 500 ms). QT drugs (91.6%), female sex (38.7%) and hypertension (10.6%) were the most common QT prolonging risk factors. Prolonged QTc interval was significantly higher among male patients (p = 0.007).ConclusionIn the present study, QT interval prolongation was observed in a considerable number of psychiatric patients. While, the high prevalence of QT prolonging risk factors among these patients warrants the increased risk of fatal arrhythmias. Therefore, risk assessment and electrocardiographic monitoring, and prescription of safer alternatives are highly recommended.
Highlights
QT interval prolongation is a growing concern worldwide, posing psychiatric patients to lifethreatening fatal arrhythmias i.e., torsade de pointes
Psychiatric patients are often exposed to psychotropic polypharmacy [11, 12], high dose therapy and illicit drug use, which considerably increase the probability of exposure to QT prolonging drugs and QT drug-drug interactions (QT-DDIs) [10, 13]
With QTcB, we noted higher prevalence of QT interval prolongation (QTIP) (27.2%) than QTcF (5.7%), details of which are provided in supplementary Table S1
Summary
QT interval prolongation is a growing concern worldwide, posing psychiatric patients to lifethreatening fatal arrhythmias i.e., torsade de pointes. This study aimed to identify the prevalence of QT interval prolongation, its associated risk factors and prescribing patterns of QT prolonging drugs among psychiatric patients. QT interval prolongation (QTIP) is a well-known surrogate marker for torsades de pointes (TdP), a lifethreatening ventricular arrhythmia, that may result in sudden cardiac death [1,2,3,4]. QTIP is a consequence of Psychiatric patients are at higher risk of drug induced TdP because majority of the psychotropic agents (antipsychotics and antidepressants) are notorious for prolonging the QT interval [7]. 19% prevalence of multi-class psychotropic polypharmacy among children and adolescents [15]. Since 1974 prescriptions containing ≥3 drugs increased from 5% to 40% in 1995 [16]
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