Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

Poncet, Antoine; Gencer, Baran; Blondon, Marc; Gex‐Fabry, Marianne; Combescure, Christophe; Shah, Dipen; Schwartz, Peter J.; Besson, Marie; Girardin, François

doi:10.1371/journal.pone.0127213

Cited by 30 publications

(30 citation statements)

References 28 publications

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“…They have adverse cardiovascular effect especially in persons with pre existing heart diseases (Roose et al Khasawneh and Shankar (2014) have implicated atypical antipsychotics with many of these abnormalities. Sudden cardiac arrest has been linked to late potentials in ECG of up to 31% of psychiatric (Poncet et al, 2015). Late ventricular potentials (LVPs) have been defined as low amplitude, high frequency waveforms that appear in the terminal part of the QRS complex of the electrocardiogram (Benchimol-Barbosa et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic recordings of psychiatric patients attending Dawanau Psychiatric hospital, Kano-Nigera

Yakasai¹,

Mukhtar²,

Salisu³

2019

Bayero J. Pure App. Sci.

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Psychiatric patients are often associated with electrocardiographic (ECG) abnormalities which may in some cases be life threatening due to the effect of anti psychotic drugs they are placed on. This study aims to establish the ECG recordings of these patie abnormalities in the ECG tracings as documented in the literature. Anthropometric and clinical data were obtained from 323 patients attending Dawanau Psychiatric Hospital between April to May 2017. Result showed there were 12 (3.7%) cases of short PR interval and 15 (5%) of prolonged PR interval. Fifteen (5%) of the subjects have prolonged QTc, 16 (5%) have ST segment elevation while 8 (2.5%) have ST segment depression and 24 (7.4%) have flat T wave. The PR and QT intervals were significantly (p<0.05) lower in females compared to the males, while the corrected QT was significantly (p<0.05) lower in the males than the females. It can be concluded that mild ECG changes exist in these psychiatric patients on antipsychotic drugs, ventricular potentials or features of Torsade de pointes.

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Section: Introductionmentioning

confidence: 99%

Electrocardiographic recordings of psychiatric patients attending Dawanau Psychiatric hospital, Kano-Nigera

Yakasai¹,

Mukhtar²,

Salisu³

2019

Bayero J. Pure App. Sci.

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“…This implies that a number of summaries need to be elicited for each quantity to define the shape of a distribution. To do this, applications have typically used one of two approaches: fixed interval method (FIM) [9] , [10] , [11] , [12] , [18] , [19] , [24] , [25] , [26] , [27] or variable interval method (VIM) [13] , [14] , [17] , [21] , [22] , [23] , [28] ( Table 2 ). In an FIM, experts are provided with ranges of values and asked to assess the probability that the quantity lies in each.…”

Section: Resultsmentioning

confidence: 99%

Experiences of Structured Elicitation for Model-Based Cost-Effectiveness Analyses

et al. 2018

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BackgroundEmpirical evidence supporting the cost-effectiveness estimates of particular health care technologies may be limited, or it may even be missing entirely. In these situations, additional information, often in the form of expert judgments, is needed to reach a decision. There are formal methods to quantify experts’ beliefs, termed as structured expert elicitation (SEE), but only limited research is available in support of methodological choices. Perhaps as a consequence, the use of SEE in the context of cost-effectiveness modelling is limited.ObjectivesThis article reviews applications of SEE in cost-effectiveness modelling with the aim of summarizing the basis for methodological choices made in each application and recording the difficulties and challenges reported by the authors in the design, conduct, and analyses.MethodsThe methods used in each application were extracted along with the criteria used to support methodological and practical choices and any issues or challenges discussed in the text. Issues and challenges were extracted using an open field, and then categorised and grouped for reporting.ResultsThe review demonstrates considerable heterogeneity in methods used, and authors acknowledge great methodological uncertainty in justifying their choices. Specificities of the context area emerging as potentially important in determining further methodological research in elicitation are between- expert variation and its interpretation, the fact that substantive experts in the area may not be trained in quantitative subjects, that judgments are often needed on various parameter types, the need for some form of assessment of validity, and the need for more integration with behavioural research to devise relevant debiasing strategies.ConclusionsThis review of experiences of SEE highlights a number of specificities/constraints that can shape the development of guidance and target future research efforts in this area.

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“…Nevertheless, the development of cost-effective ECG-monitoring algorithms and their implementation remains challenging, for MQAB users as well as for other high risk groups such as users of psychiatric drugs [39]. …”

Section: Discussionmentioning

confidence: 99%

Drug safety of macrolide and quinolone antibiotics in a tertiary care hospital: administration of interacting co-medication and QT prolongation

Niedrig

Maechler

Hoppe

et al. 2016

Eur J Clin Pharmacol

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PURPOSE Some macrolide and quinolone antibiotics (MQABs) are associated with QT prolongation and life-threatening torsade de pointes (TdP) arrhythmia. MQAB may also inhibit cytochrome P450 isoenzymes and thereby cause pharmacokinetic drug interactions (DDIs). There is limited data on the frequency and management of such risks in clinical practice. We aimed to quantify co-administration of MQAB with interacting drugs and associated adverse drug reactions. METHODS We conducted an observational study within our pharmacoepidemiological database derived from electronic medical records of a tertiary care hospital. Among all users of MQAB associated with TdP, we determined the prevalence of additional QT-prolonging drugs and risk factors and identified contraindicated co-administrations of simvastatin, atorvastatin, or tizanidine. Electrocardiographic (ECG) monitoring and associated adverse events were validated in medical records. RESULTS Among 3444 administered courses of clarithromycin, erythromycin, azithromycin, ciprofloxacin, levofloxacin, or moxifloxacin, there were 1332 (38.7 %) with concomitant use of additional QT-prolonging drugs. Among those, we identified seven cases of drugrelated QT prolongation, but 49.1 % had no ECG monitoring. Of all MQAB users, 547 (15.9 %) had hypokalemia. Forty-four MQAB users had contraindicated co-administrations of simvastatin, atorvastatin, or tizanidine and three of those related adverse drug reactions. CONCLUSION In the studied real-life setting, we found a considerable number of MQAB users with additional risk factors for TdP but no ECG monitoring. However, adverse drug reactions were rarely found, and costs vs. benefits of ECG monitoring have to be weighted. In contrast, avoidable risk factors and selected contraindicated pharmacokinetic interactions are clear targets for implementation as automated alerts in electronic prescribing systems. with concomitant use of additional QT-prolonging drugs. Among those we identified 7 adverse drug reactions related to QT-prolongation, but 49.1 % had no ECGmonitoring. Of all MQAB users 547 (15.9 %) had hypokalemia. Forty-four MQAB users had contraindicated co-administrations of simvastatin, atorvastatin or tizanidine, and 3 of those related adverse drug reactions. ConclusionIn the studied real-life setting we found a considerable number of MQAB users with additional risk factors for TdP but no ECG monitoring. However, adverse drug reactions were rarely found, and costs vs. benefits of ECG monitoring have to be weighted. In contrast, avoidable risk factors and selected contraindicated pharmacokinetic interactions are clear targets for implementation as automated alerts in electronic prescribing systems.

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Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

Cited by 30 publications

References 28 publications

Electrocardiographic recordings of psychiatric patients attending Dawanau Psychiatric hospital, Kano-Nigera

Electrocardiographic recordings of psychiatric patients attending Dawanau Psychiatric hospital, Kano-Nigera

Experiences of Structured Elicitation for Model-Based Cost-Effectiveness Analyses

Drug safety of macrolide and quinolone antibiotics in a tertiary care hospital: administration of interacting co-medication and QT prolongation

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