Vascular Health and Risk Management (Feb 2024)

Prevalence of Medication Associated with QTc Prolongation Used Among Critically Ill Patients

  • Al-Azayzih A,
  • Al-Qerem W,
  • Al-Azzam S,
  • Muflih S,
  • Al-Husein BA,
  • Kharaba Z,
  • Kanaan RJ,
  • Rahhal D

Journal volume & issue
Vol. Volume 20
pp. 27 – 37

Abstract

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Ahmad Al-Azayzih,1 Walid Al-Qerem,2 Sayer Al-Azzam,1 Suhaib Muflih,1 Belal A Al-Husein,1 Zelal Kharaba,3,4 Roaa J Kanaan,1 Dania Rahhal1 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 2Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan; 3College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates; 4Honorary Associate Lecturer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UKCorrespondence: Ahmad Al-Azayzih, Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan, Email [email protected]: Acquired prolonged corrected QT (QTc) interval can lead to life-threatening Torsade de Pointes (TdP) arrhythmia. Multiple risk factors including medications, comorbidities, and electrolyte imbalances contribute significantly to acquired manifestations of the QTc prolongation. Critically ill patients are particularly more vulnerable to TdP due to complex medical conditions, aging, and polypharmacy.Objective: This study aimed to assess the prevalence of TdP-associated medication prescribing, identify risk factors for QTc prolongation and TdP, and determine primary predictors of high TdP medication usage in critically ill patients in Jordan.Methods: We conducted a retrospective cross-sectional analysis of electronic medical records for patients from King Abdullah University Hospital who were admitted to Intensive Care Unit (ICU) between (July 2012-July 2022). We collected data on patients’ demographics, clinical characteristics, comorbidities, laboratory results, and prescribed medications. Medications were categorized into three TdP risk levels according to CredibleMeds® assessment tool. Data were analyzed using descriptive statistics and a binary logistic regression model.Results: Of the 13,300 patients (58.2% male, median age 62 years). Prescribing prevalence for medications with known TdP risk was 19%, possible risk (24.7%), conditional risk (21.6%), and confirmed conditional risk (8.3%). Common comorbidities included hypertension (40.9%), diabetes (33.3%), and cancer (15.4%). Drugs with known TdP risk included citalopram, amiodarone, clarithromycin, and ciprofloxacin. A binary regression model revealed that as age increased, the odds of TdP associated medication prescribing decreased (OR = 0.989, p < 0.001), while patients on more than five medications had higher odds (OR = 4.281, p < 0.001).Conclusion: The study identified a notable prevalence of prescribing for medications with QTc prolongation/TdP risk in critically ill patients. Healthcare providers in the ICU should exercise caution to minimize the inadvertent prescription of TdP associated medications especially among older patients and those with polypharmacy.Keywords: torsade de pointes, QTc interval, critically ill patients, Jordan, intensive care unit

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