Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Zolezzi, Monica; Elhakim, Athar; Elamin, Waad M; Homs, Shorouk; Mahmoud, Doaa Elsayed; Qubaiah, Iman A

doi:10.2147/ndt.s334350

Cited by 2 publications

(4 citation statements)

References 37 publications

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“…One is a literature review conducted by pharmacists in Qatar and Canada which included 31 articles to create an algorithm for the assessment, management, and monitoring of drug-induced QTc prolongation in psychiatric patients [ 24 ]. While this algorithm has been validated, it has not been recognized by major associations [ 27 , 28 ]. The second guidance cited is from the Association of Medicine and Psychiatry and also includes an algorithm determined by a literature search and review of AHA, APA, and other society guidelines [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Pharmacist Reported Protocols for QTc Monitoring of Psychiatric Medications

Harb,

Schwartz,

Cooper

2024

Cureus

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Background Psychiatric medications, such as antipsychotics and antidepressants, are associated with QTc interval prolongation. There is currently no consensus best practice on how to mitigate this risk. This study aimed to collect and analyze information about methods used for QTc monitoring in patients taking psychiatric medications to better understand current practice. Methods An anonymous electronic survey was distributed on September 22, 2022, using a national psychiatric pharmacist organization email list. The survey closed on December 15, 2022. Descriptive statistics were used to analyze the multiple-choice questions. Qualitative analysis applying grounded theory for thematic analysis was performed for free response questions. Results A total of 48 initiated the survey. Of the respondents, 11.4% (5/44) reported that their institution had a formal protocol for monitoring QTc intervals in patients receiving psychiatric medications, while 32.4% (12/37) reported that their institution had an informal process. Out of those with a protocol or process, approximately half reported that it was drug-specific. Among the respondents, 88.6% (31/35) reported that there was a psychiatric clinical pharmacy specialist at their institution and 34.3% (12/35) reported that pharmacists could order an electrocardiogram (ECG). Major themes that emerged from the qualitative analysis included pharmacist-driven QTc monitoring, referring the patient to another provider for monitoring, and encountering significant barriers to monitoring. Conclusion A variety of methods are currently being employed to monitor QTc prolongation risk in patients taking psychiatric medications. Pharmacist authorization to order ECGs may be an opportunity to advance practice and improve care for this population. Further research is needed to more clearly understand best practices for QTc prolongation risk mitigation in patients receiving psychiatric medications.

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Section: Discussionmentioning

confidence: 99%

Pharmacist Reported Protocols for QTc Monitoring of Psychiatric Medications

Harb,

Schwartz,

Cooper

2024

Cureus

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“…Overall, a positive inter-rater reliability was observed with Ave-CVI, I-CVI and κ* values well above the recommended cut-offs. Although several algorithms have been proposed for the assessment of QTcIP, this is the first which has been validated by cardiology experts, 16 and now through this evaluation, by mental health clinicians. Over the past decade, physicians have become more aware of the potential risk of TdP with the use of psychotropic medications, but there is significant variability in practice and policy at the individual and institutional levels.…”

Section: Discussionmentioning

confidence: 99%

“…In the first study, content was validated by field experts (cardiologists) while in this study, the perspectives of mental health practitioners complemented the results obtained in the initial content validation study. 16 …”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] We have previously reported on the development of a stepped-based algorithm specifically to assess the risk of druginduced QTcIP in the psychiatric population, 15 and reported the results of the evaluation of the algorithm's content validity as assessed by a panel of cardiologists. 16 In this article we report on the evaluation of the same algorithm by mental health practitioners, in an effort to address current practice gaps in the assessment, management and monitoring of drug-induced QTcIP risk, in settings where cardiology consultations are limited or hard to reach.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Drug-Induced QTc Prolongation in Mental Health Practice: Validation of an Evidence-Based Algorithm

Zolezzi,

Elhakim,

Qubaiah

et al. 2023

RMHP

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Background Drug-induced QTc interval prolongation (QTcIP) can lead to serious consequences and is often a concern for mental health practitioners, as access to experts such as cardiologists, for consultation is time-limiting and can delay treatment decisions. This research aimed at validating the content of an algorithm for the assessment, management and monitoring of drug-induced QTcIP in mental health practice. Methods Following an initial face validity by content experts, a cross-sectional survey of mental health care practitioners with a 4-point Likert-type scale was used to assess the validity of the decision steps on the QTcIP algorithm (QTcIPA) by estimating the content validity index (CVI) and the modified kappa statistic (κ*). Participants’ open-ended comments were also thematically analyzed. Results Mental health practitioners found the QTcIPA to be appropriate, safe, and evidence-based, as indicated by the high individual item CVI scores ranging from 0.89 to 1 for all of the steps/decision statements in the three domains assessed: appropriateness, safety and reliability of the references used. Five themes emerged from the qualitative analysis of the open-ended comments, of which three were identified as strengths, including practical usability, reliable references and beneficial for pharmacists. Two themes were recognized as limitations, namely, the need for additional clinical content and application barriers. Conclusion These results suggest that the QTcIPA may be a useful tool for mental health clinicians at the time of prescribing medications with potential risk of QTcIP. Future research will explore the implementation of the QTcIPA into clinical practice using computerized decision support tools through web-based and mobile applications.

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Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Cited by 2 publications

References 37 publications

Pharmacist Reported Protocols for QTc Monitoring of Psychiatric Medications

Pharmacist Reported Protocols for QTc Monitoring of Psychiatric Medications

Assessment of Drug-Induced QTc Prolongation in Mental Health Practice: Validation of an Evidence-Based Algorithm

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