Identification of Risk of QT Prolongation by Pharmacists When Conducting Medication Reviews in Residential Aged Care Settings: A Missed Opportunity?

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.

Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): protocol for a cluster randomised controlled trial

“…Another large Australian study reported that more than 50% of residents were prescribed proton pump inhibitors with a median duration of use of 360 days in the year, while the recommended duration of use is 8 weeks [27]. Over-prescribing can also lead to unwanted drug interactions; a retrospective study of aged care resident's medication records showed that 16% of residents were at high risk of drug-induced QT prolongation and potential arrhythmia due to polypharmacy [33]. Overall, many published studies highlight the need to improve medication management in RACFs.…”

Community pharmacist use of mobile ECG to inform drug therapy decision making for patients receiving QTc prolonging medications

“…Prescription dispensing software programs used in community pharmacies frequently issue safety alerts for QT c interval drug interactions, 10 but studies suggest that pharmacists intervene in only a minority (9%-23%) of situations involving patients at high risk of DiLQTS. 13,14 Better targeting and monitoring of DiLQTS could prevent serious events like TdP. The use of handheld ECG devices to measure QT c intervals have been piloted in small samples in healthy volunteers at a health fair, 15 or with a specific medication 16 which support feasibility, but little work has used this technology to inform drug therapy recommendations.…”

“…Predictive analytics integrated into clinical decision support tools have been piloted to alert clinicians about patients at high risk of developing DiLQTS 12 but uptake remains low and the impact of these tools on outcomes such as TdP and SCD has not been established. Prescription dispensing software programs used in community pharmacies frequently issue safety alerts for QT c interval drug interactions, 10 but studies suggest that pharmacists intervene in only a minority (9%‐23%) of situations involving patients at high risk of DiLQTS 13,14 . Better targeting and monitoring of DiLQTS could prevent serious events like TdP.…”

Interações Medicamentosas Prolongadoras do Intervalo QT em Unidade de Terapia Intensiva: Coorte de idosos

“…Os estudos que envolvem o risco de ALQTS em pacientes idosos mostram uma alta prevalência de uso de medicamentos prolongadores do intervalo QT, com 23% dos idosos em uso de pelo menos um medicamento com "Risco conhecido" de prolongamento do intervalo QT (14) . Prescrições concomitantes de dois ou mais medicamentos prolongadores de QT foram observadas em 22,1% dos idosos na Bavária.…”

“…Houve uma alta prevalência, com 23% dos idosos em uso de pelo menos um medicamento com "Risco conhecido" de prolongar o intervalo QT. Entre os 945 medicamentos prescritos com risco de prolongamento do intervalo QT, os antipsicóticos foram os mais comuns (26%), seguidos pelos antidepressivos (19%) e inibidores da bomba de prótons (13%) (14) .…”