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Background Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. Methods Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. Results Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. Conclusions Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. Aims This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.
Background Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. Methods Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. Results Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. Conclusions Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. Aims This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.
Objective: To investigate the predictive value of corrected QT (QTc)interval and neutrophil to lymphocyte ratio (NLR) on major adverse cardiovascular events (MACE) in patients with chronic heart failure (CHF) within one year. Methods: Retrospective in January 2018 to June 2021 in Hebei province people's hospital of cardiovascular internal medicine in hospital patients with CHF, MACE grouped according to whether the patients within 1 year, collect patients clinical data, electrocardiogram (ECG) index, other auxiliary examination and medications, for all the patients by telephone, follow-up outpatient care or electronic medical records, The incidence of MACE within 1 year after discharge was followed up. Multivariate Logistic regression analysis was used to explore the influencing factors of MACE events in patients within 1 year. ROC was used to analyze the predictive value of QTc interval NLR and their combination on the occurrence of MACE in patients with CHF within 1 year. Results: A total of 622 patients were enrolled, including 371 in the MACE group and 251 in the non-MACE group. Compared with the non-MACE group, the MACE group had higher age, proportion of cerebral infarction, QRS duration, QT interval, QTc interval, neutrophil count, NLR, creatinine, treatments with beta-blockers, aldosterone antagonists rate, and lower admission heart rate, ventricular rate, lymphocyte count, and hemoglobin content (P<0.05).Multivariate Logistic regression analysis showed that age, admission heart rate, QTc interval, NLR and beta-blocker use rate are the influencing factors of MACE events(P<0.05). ROC analysis estimating the performance in predicting the occurrence of MACE within 1 year in patients with showed that the area under curve(AUC)of QTc interval, score was 0.652(95%CI:0.609-0.695,P<0.001) with 0.624 sensitivity and 0.61 specificity when the optimal cut-off value was determined as 428.5,the AUC of NLR was 0.649(95%CI:0.605-0.692,P<0.001)with 0.523 sensitivity and 0.738 specificity when the optimal cut-off value was determined as 4.016, and the AUC of QTc interval and NLR was 0.719(95%CI:0.678-0.760,P<0.001)with 0.679 sensitivity and 0.695 specificity when the optimal cut-off value was determined as 0.583. Conclusion: Prolongation of QTc interval and elevation of NLR may be independent risk factors for MACE in CHF patients within 1 year, and their combination can be used as predictors of MACE in CHF patients within 1 year.
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