Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People

Abstract

Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.

Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register

“…We also became aware that there is a need for a closer alliance between internists and geriatricians in the management of the oldest patients, and that the internists must become more proficient with the routine use of the tools of the comprehensive geriatric assessment [40]. This also entails the promotion and implementation of High frequency of polypharmacy (67% at discharge) [10] A gender difference in overall medication pattern in the hospitalized elderly is found: hospitalization, while increasing the number of prescriptions, does not change drug distribution by gender [33] The prevalence of patients with chronic pain prescribed with opioids is low at admission (4%) and increases only slightly at discharge (6%) [26] The strongest association between clusters of diseases and polypharmacy is found for diabetes mellitus plus coronary heart disease plus cardiovascular disease, diabetes plus coronary heart disease, and heart failure plus atrial fibrillation [36] From 2010 to 2016, there is an increasing number of patients who, on polypharmacy at hospital admission, decrease drug intake at hospital discharge [31] Appropriateness of drug prescribing Severe drug-drug interactions are frequent (24%) and associated with an increased risk of 3-month mortality (odds ratio: 2.62) [12] The prevalence of patients receiving at least one potentially inappropriate medication is 20 and 24% according to the 2003 and 2012 versions of the Beers' criteria [13] The prevalence of patients exposed to at least one therapeutic duplicate rises significantly from hospital admission (2.5%) to discharge (3.4%; p = 0.003) [28] There is a high frequency (63%) of inappropriate prescription of proton pump inhibitors [14] Among patients treated with antiplatelet therapy for primary prevention, 52% are inappropriately prescribed (mainly overprescribed, 74%), also with a high rate of inappropriate underprescription in the context of secondary prevention (30%) [18] Appropriate antithrombotic prophylaxis has a prevalence of less than 50% in patients with atrial fibrillation, with an underuse of vitamin K antagonists agents independent of the level of cardio-embolic risk [19] Non-compliance to guidelines is highly prevalent among elderly patients with atrial fibrillation, despite guideline-compliant treatment being independently associated with lower risk of all-cause and cardiovascular deaths [20] Among patients treated with allopurinol more than 90% are treated inappropriately at admission and at discharge [17] Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons [44] Prognostic measures The number of drugs is significantly associated with the likelihood of readmission at 3 months [11] The documentation of delirium is poor (2.9%) on medical wards of Italian acute hospitals [30] Pat...…”

Effects of atypical antipsychotic drugs on QT interval in patients with mental disorders

“…The risk of drug-induced prolongation of QT is much higher in older adults and people with multiple chronic conditions (4). Psychotropic drugs including atypical antipsychotic agents are commonly prescribed for licensed and off-label indications and may contribute to the higher risk of drug-induced QT prolongation (5,6).…”

The risk of cardiac events in patients who received concomitant levofloxacin and amiodarone

“…Various risk factors have been identified including age, female sex, polypharmacy, and electrolyte imbalance (Nachimuthu et al, 2012;Franchi et al, 2016;Zeltser et al, 2003;Bednar et al, 2002). The use of medications that prolong the QT interval is common, with one study reporting that >50% of patients were taking a least one QT-prolonging medication upon hospital admission (Franchi et al, 2016). Further, many hospitalized patients have multiple risk factors for QT prolongation, placing them at an increased risk of cardiac events (Zeltser et al, 2003).…”