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RESEARCH PRODUCT

Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People

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subject

MaleTORSADES-DE-POINTES INTERVAL PROLONGATION PATIENT CIPROFLOXACIN COHORT DEATH MULTIMORBIDITY AMIODARONE MORTALITY AIFA.Amiodarone030204 cardiovascular system & hematologyCIPROFLOXACINLogistic regressionAmiodaroneElectrocardiography0302 clinical medicineRisk FactorsTorsades de PointesAtrial Fibrillation80 and overPrevalencePharmacology (medical)030212 general & internal medicineAged; Aged 80 and over; Amiodarone; Atrial Fibrillation; Electrocardiography; Female; Humans; Long QT Syndrome; Male; Middle Aged; Patient Discharge; Prevalence; Risk Factors; Torsades de Pointes; Hospitalizationmedia_commonAged 80 and overTorsades de PointeAged; Aged 80 and over; Amiodarone; Atrial Fibrillation; Electrocardiography; Female; Humans; Long QT Syndrome; Male; Middle Aged; Patient Discharge; Prevalence; Risk Factors; Torsades de Pointes; Hospitalization; Pharmacology (medical); Geriatrics and Gerontology; Medicine (all)Medicine (all)DEATHMiddle AgedPatient DischargeHospitalizationLong QT SyndromeCohortHospitalized Older PeopleFemalemedicine.drugHumanDrugmedicine.medical_specialtymedia_common.quotation_subjectMULTIMORBIDITYTorsades de pointesPATIENT03 medical and health sciencesPharmacotherapyInternal medicineINTERVAL PROLONGATIONmedicineHumansTORSADES-DE-POINTESCOHORTMedical prescriptionAIFAAgedbusiness.industryMORTALITYRisk FactorSettore MED/09 - MEDICINA INTERNAOdds ratiomedicine.diseaseQT-Prolonging DrugAged; Aged 80 and over; Amiodarone; Atrial Fibrillation; Electrocardiography; Female; Humans; Long QT Syndrome; Male; Middle Aged; Patient Discharge; Prevalence; Risk Factors; Torsades de Pointes; Hospitalization; Geriatrics and Gerontology; Pharmacology (medical)Physical therapyGeriatrics and Gerontologybusiness

description

Aims: The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older). Methods: Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed. Results: Among 3906 patients prescribed at least one drug at admission, 2156 (55.2 %) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95 % CI 1.01–1.03), multimorbidity (OR 2.69, 95 % CI 2.33–3.10), hypokalemia (OR 2.79, 95 % CI 1.32–5.89), atrial fibrillation (OR 1.66, 95 % CI 1.40–1.98), and heart failure (OR 3.17, 95 % CI 2.49–4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8 % were prescribed them at discharge. Conclusions: Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.

yearjournalcountryeditionlanguage
2016-01-01
10.1007/s40266-015-0337-yhttp://hdl.handle.net/2318/1730019