Aims: Drugs that prolong the QT interval, either by design (cardiac QT-prolonging drugs: anti-arrhythmics) or as off-target effect (non-cardiac QT-prolonging drugs), may increase the risk of ventricular arrhythmias and out-of-hospital cardiac arrest (OHCA). Risk mitigation measures were instituted, in particular, surrounding prescription of cardiac QT-prolonging drugs. We studied OHCA risk of both drug types in current clinical practice.
Methods: Using data from large population-based OHCA registries in the Netherlands and Denmark, we conducted two independent case-control studies. OHCA cases with presumed cardiac causes were matched on age/sex/index date with up to five non-OHCA controls. We calculated odds ratios (ORs) for the association of cardiac or non-cardiac QT-prolonging drugs with OHCA risk using conditional logistic regression analyses.
Results: We identified 2503 OHCA cases and 10 543 non-OHCA controls in the Netherlands, and 35 017 OHCA cases and 175 085 non-OHCA controls in Denmark. Compared to no use of QT-prolonging drugs, use of non-cardiac QT-prolonging drugs (Netherlands: cases: 3.0%, controls: 1.9%; Denmark: cases: 14.9%, controls: 7.5%) was associated with increased OHCA risk (Netherlands: OR 1.37 [95% CI: 1.03-1.81]; Denmark: OR 1.63 [95% CI: 1.57-1.70]). The association between cardiac QT-prolonging drugs (Netherlands: cases: 4.0%, controls: 2.5%; Denmark: cases: 2.1%, controls: 0.9%) and OHCA was weaker (Netherlands: OR 1.17 [95% CI: 0.92-1.50]; Denmark: OR 1.21 [95% CI: 1.09-1.33]), although users of cardiac QT-prolonging drugs had more medication use and comorbidities associated with OHCA risk than users of non-cardiac QT-prolonging drugs.
Conclusion: In clinical practice, cardiac QT-prolonging drugs confer lower OHCA risk than non-cardiac QT-prolonging drugs, although users of the former have higher a priori risk. This is likely due to risk mitigation measures surrounding prescription of cardiac QT-prolonging drugs.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291302 | PMC |
| http://dx.doi.org/10.1111/bcp.15030 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The Frequency and Incidence of QT Prolongation with Extended Use of Bedaquiline or Delamanid in a Large, Multi-Country MDR/RR-TB Cohort.
Clin Infect Dis
December 2024
Interactive Research & Development (IRD) Global, Singapore, Singapore.
Background: The 2022 WHO guidelines on multi-drug/rifampicin resistant tuberculosis (MDR/RR-TB) recommend six months of bedaquiline (Bdq) in the all-oral 9-month shorter regimen and six months or longer for Bdq and delamanid (Dlm) in the 18-20-month longer regimen. However, lack of evidence on extended treatment using Bdq or Dlm has limited their use to six months. We examine the frequency and incidence of QT prolongation based on duration of Bdq and/or Dlm use in longer regimens.
View Article and Find Full Text PDFVentricular arrhythmias after atrial fibrillation electrical cardioversion: A multicenter study.
Heart Rhythm O2
November 2024
Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
Article Synopsis
- Ventricular arrhythmias (VAs) are uncommon but can occur after electrical cardioversion (ECV) for atrial fibrillation (AF), with an incidence of about 0.2% based on a study of nearly 12,000 ECV procedures.
- The study involved 23 patients who experienced VAs within 10 days of ECV, with most cases developing 28.5 hours after the procedure, and a significant number had underlying health issues like congestive heart failure.
- The findings suggest that while VAs post-ECV are rare, they can be life-threatening, especially in patients with certain risk factors, indicating that careful monitoring is essential for these individuals.
[Drug-induced QT interval prolongation. Evaluating the prevalence of potentially fatal cardiac arrhythmias in a specific cohort of patients].
MMW Fortschr Med
November 2024
Institut für Rechtsmedizin, Klinikum Innenstadt der LMU München, Nußbaumstraße 26, 80336, München, Deutschland.
Article Synopsis
- Some medications can increase the QT interval, which can be life-threatening, especially when combined with other risk factors.
- In a study of 3040 forensic autopsy cases over five years, 6% showed at least one drug that could prolong the QT interval among individuals with undetermined causes of death.
- Key risk factors linked to fatal heart issues included a history of drug or alcohol abuse, heart problems, and the use of multiple QT-prolonging medications, with antipsychotics being the most commonly found among these cases.
Polygenic risk score for drug-induced long QT syndrome: independent validation in a real-world patient cohort.
Pharmacogenet Genomics
January 2025
Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan.
Article Synopsis
- Drug-induced long QT syndrome (diLQTS) is a serious side effect of over 150 medications that can lead to dangerous heart conditions; the study aimed to validate a genetic risk score for predicting this syndrome.
- Researchers analyzed data from a large cohort of patients taking high-risk QT-prolonging drugs and found that the risk score was significantly associated with diLQTS in White patients, indicating a higher likelihood of QT prolongation during treatment.
- Although the risk score showed promise in identifying high-risk individuals, the study was underpowered to confirm its effectiveness across African American and Asian populations, highlighting the need for larger sample sizes in diverse groups.
Assessing the Risk of QT Prolongation in a Psychiatric Inpatient Cohort: A Retrospective Cross-Sectional Study.
Pharmaceuticals (Basel)
October 2024
Research Unit for Clinical Psychopharmacology, Mental Health Service West, Copenhagen University Hospital-Psychiatry West Region Zealand, 4200 Slagelse, Denmark.
Background: QT prolongation is a potential serious adverse drug reaction, and assessing the risk of QT-prolonging drugs is routinely included in psychotropic medication reviews. However, the actual clinical benefits of such assessments are unknown. We investigate whether QT prolongation (QTc value > 480 ms) manifests in psychiatric inpatients at risk of QT prolongation as identified by assessing drug regimens.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!