Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting

Martin Schulze Westhoff; Sebastian Schröder; Johannes Heck; Tabea Pfister; Kirsten Jahn; Olaf Krause; Felix Wedegärtner; Stefan Bleich; Kai G Kahl; Tillmann H C Krüger; Adrian Groh

doi:10.3389/fpsyt.2023.1157996

Determinants of severe QT_c prolongation in a real-world gerontopsychiatric setting

Front Psychiatry. 2023 Mar 23:14:1157996. doi: 10.3389/fpsyt.2023.1157996. eCollection 2023.

Authors

Affiliations

¹ Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
² Hannover Medical School, Institute for Clinical Pharmacology, Hannover, Germany.
³ Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany.
⁴ Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Hannover, Germany.
⁵ Center for Systemic Neursocience, Hannover, Germany.

Abstract

Introduction: QT_c prolongation carries the risk of ventricular tachyarrhythmia (Torsades de Pointes) and sudden cardiac death. Psychotropic drugs can affect ventricular repolarization and thus prolong the QT_c interval. The present study sought to investigate the risk factors (pharmacological and non-pharmacological) of severe QT_c prolongation in gerontopsychiatric patients.

Methods: Electrocardiograms of patients on a gerontopsychiatric ward were screened for QT_c prolongation. Medication lists were examined utilizing the AzCERT classification. Potential drug interactions were identified with the electronic drug interaction program mediQ.

Results: The overall prevalence of QT_c prolongation was 13.6%, with 1.9% displaying severe QT_c prolongation (≥ 500 ms). No statistically significant differences between patients with moderate and severe QT_c prolongation were identified; however, patients with severe QT_c prolongation tended to take more drugs (p = 0.063). 92.7% of patients with QT_c prolongation took at least one AzCERT-listed drug, most frequently risperidone and pantoprazole. Risperidone and pantoprazole, along with pipamperone, were also most frequently involved in potential drug interactions. All patients displayed additional risk factors for QT_c prolongation, particularly cardiac diseases.

Conclusion: In addition to the use of potentially QT_c-prolonging drugs, other risk factors, especially cardiac diseases, appear to be relevant for the development of QT_c prolongation in gerontopsychiatric patients. Pantoprazole was frequently involved in potential drug interactions and should generally not be used for more than 8 weeks in geriatric populations. As clinical consequences of QT_c prolongation were rare, potentially QT_c-prolonging drugs should not be used overcautiously; their therapeutic benefit should be considered as well. It is paramount to perform diligent benefit-risk analyses prior to the initiation of potentially QT_c-prolonging drugs and to closely monitor their clinical (side) effects.

Keywords: AzCERT classification; QTc prolongation; drug safety; elderly; geriatric psychiatry; geriatrics.