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

Ahmad Al-Azayzih; Walid Al-Qerem; Sayer Al-Azzam; Suhaib Muflih; Belal A Al-Husein; Zelal Kharaba; Roaa J Kanaan; Dania Rahhal

doi:10.2147/VHRM.S438899

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

Vasc Health Risk Manag. 2024 Feb 1:20:27-37. doi: 10.2147/VHRM.S438899. eCollection 2024.

Authors

Ahmad Al-Azayzih¹, Walid Al-Qerem², Sayer Al-Azzam¹, Suhaib Muflih¹, Belal A Al-Husein¹, Zelal Kharaba^{3

4}, Roaa J Kanaan¹, Dania Rahhal¹

Affiliations

¹ Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
² Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan.
³ College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates.
⁴ Honorary Associate Lecturer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.

Abstract

Background: 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: Jordan; QTc interval; critically ill patients; intensive care unit; torsade de pointes.

MeSH terms

Critical Illness
Cross-Sectional Studies
DNA-Binding Proteins
Electrocardiography
Female
Humans
Long QT Syndrome* / chemically induced
Long QT Syndrome* / diagnosis
Long QT Syndrome* / epidemiology
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
Torsades de Pointes* / chemically induced
Torsades de Pointes* / diagnosis
Torsades de Pointes* / epidemiology

Substances

DNA-Binding Proteins