Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study
Objective Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objec...
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creator | Goutelle, Sylvain Sidolle, Elodie Ducher, Michel Caron, Jacques Timour, Quadiri Nony, Patrice Gouraud, Aurore |
description | Objective
Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS.
Methods
In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP (
n
= 125) and LQTS without TdP (
n
= 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP.
Results
The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms;
p
= 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms.
Conclusion
The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS. |
doi_str_mv | 10.1007/s40266-014-0188-y |
format | Article |
fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04638223v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3528703571</sourcerecordid><originalsourceid>FETCH-LOGICAL-c506t-f1c654124aa41753b0243a639c4f27c9c4e7c8ccadec9a9a3c4244a27eac66633</originalsourceid><addsrcrecordid>eNp1kU1v1DAQhiNERT_gB3BBlhCHHlz8tU7MbbUFWmmlFnWRuFlTx9m6ytqt7YDy73HItnDhMJqR55nXr_RW1VtKzigh9cckCJMSEypKNQ0eX1RHlNYKUyXVyz8zwYypH4fVcUr3hBDJGH1VHTKhGOeNOKoez222cec8-JxQ6NAmxAStTai16Do4n8voPLrqWxvRNWRnJ_CXy3foPA5bvEwpGAfZtmgd_BZ926Cb0bcx7OwntEQrSBavgs8x9OgmD-34ujrooE_2zb6fVN-_fN6sLvD66uvlarnGZkFkxh01ciEoEwCC1gt-S5jgILkyomO1Kc3WpjGmeDUKFHAjmBDAagtGSsn5SXU6695Brx-i20EcdQCnL5ZrPb0RIXnDGP9JC_t-Zh9ieBxsyvo-DNEXe5pKLmuqiFwUis6UiSGlaLtnWUr0FIieA9ElED0Fosdy826vPNzubPt88ZRAAT7sAUgG-i6CNy795RpJFJeTRTZzqaz81sZ_LP73999S9KIs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1636719065</pqid></control><display><type>article</type><title>Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study</title><source>MEDLINE</source><source>Springer Online Journals</source><creator>Goutelle, Sylvain ; Sidolle, Elodie ; Ducher, Michel ; Caron, Jacques ; Timour, Quadiri ; Nony, Patrice ; Gouraud, Aurore</creator><creatorcontrib>Goutelle, Sylvain ; Sidolle, Elodie ; Ducher, Michel ; Caron, Jacques ; Timour, Quadiri ; Nony, Patrice ; Gouraud, Aurore</creatorcontrib><description>Objective
Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS.
Methods
In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP (
n
= 125) and LQTS without TdP (
n
= 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP.
Results
The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms;
p
= 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms.
Conclusion
The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-014-0188-y</identifier><identifier>PMID: 24923384</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Anti-Arrhythmia Agents ; Anti-Arrhythmia Agents - adverse effects ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Case-Control Studies ; Databases, Pharmaceutical ; Diuretics ; Drug therapy ; Female ; France ; France - epidemiology ; Geriatrics ; Geriatrics/Gerontology ; Health Services for the Aged ; Heart ; Humans ; Internal Medicine ; Life Sciences ; Logistic Models ; Long QT Syndrome ; Long QT Syndrome - chemically induced ; Long QT Syndrome - complications ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Original Research Article ; Patients ; Pharmaceutical sciences ; Pharmacology ; Pharmacology. Drug treatments ; Pharmacology/Toxicology ; Pharmacotherapy ; Pharmacovigilance ; Prescription drugs ; Regression analysis ; Retrospective Studies ; Risk factors ; Torsades de Pointes ; Torsades de Pointes - complications ; Torsades de Pointes - epidemiology</subject><ispartof>Drugs & aging, 2014-08, Vol.31 (8), p.601-609</ispartof><rights>Springer International Publishing Switzerland 2014</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Springer Science & Business Media Aug 2014</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-f1c654124aa41753b0243a639c4f27c9c4e7c8ccadec9a9a3c4244a27eac66633</citedby><cites>FETCH-LOGICAL-c506t-f1c654124aa41753b0243a639c4f27c9c4e7c8ccadec9a9a3c4244a27eac66633</cites><orcidid>0000-0002-1853-2932</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-014-0188-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-014-0188-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28609361$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24923384$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04638223$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Goutelle, Sylvain</creatorcontrib><creatorcontrib>Sidolle, Elodie</creatorcontrib><creatorcontrib>Ducher, Michel</creatorcontrib><creatorcontrib>Caron, Jacques</creatorcontrib><creatorcontrib>Timour, Quadiri</creatorcontrib><creatorcontrib>Nony, Patrice</creatorcontrib><creatorcontrib>Gouraud, Aurore</creatorcontrib><title>Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><description>Objective
Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS.
Methods
In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP (
n
= 125) and LQTS without TdP (
n
= 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP.
Results
The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms;
p
= 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms.
Conclusion
The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</description><subject>Aged</subject><subject>Anti-Arrhythmia Agents</subject><subject>Anti-Arrhythmia Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Case-Control Studies</subject><subject>Databases, Pharmaceutical</subject><subject>Diuretics</subject><subject>Drug therapy</subject><subject>Female</subject><subject>France</subject><subject>France - epidemiology</subject><subject>Geriatrics</subject><subject>Geriatrics/Gerontology</subject><subject>Health Services for the Aged</subject><subject>Heart</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Life Sciences</subject><subject>Logistic Models</subject><subject>Long QT Syndrome</subject><subject>Long QT Syndrome - chemically induced</subject><subject>Long QT Syndrome - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research Article</subject><subject>Patients</subject><subject>Pharmaceutical sciences</subject><subject>Pharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Pharmacovigilance</subject><subject>Prescription drugs</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Torsades de Pointes</subject><subject>Torsades de Pointes - complications</subject><subject>Torsades de Pointes - epidemiology</subject><issn>1170-229X</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kU1v1DAQhiNERT_gB3BBlhCHHlz8tU7MbbUFWmmlFnWRuFlTx9m6ytqt7YDy73HItnDhMJqR55nXr_RW1VtKzigh9cckCJMSEypKNQ0eX1RHlNYKUyXVyz8zwYypH4fVcUr3hBDJGH1VHTKhGOeNOKoez222cec8-JxQ6NAmxAStTai16Do4n8voPLrqWxvRNWRnJ_CXy3foPA5bvEwpGAfZtmgd_BZ926Cb0bcx7OwntEQrSBavgs8x9OgmD-34ujrooE_2zb6fVN-_fN6sLvD66uvlarnGZkFkxh01ciEoEwCC1gt-S5jgILkyomO1Kc3WpjGmeDUKFHAjmBDAagtGSsn5SXU6695Brx-i20EcdQCnL5ZrPb0RIXnDGP9JC_t-Zh9ieBxsyvo-DNEXe5pKLmuqiFwUis6UiSGlaLtnWUr0FIieA9ElED0Fosdy826vPNzubPt88ZRAAT7sAUgG-i6CNy795RpJFJeTRTZzqaz81sZ_LP73999S9KIs</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Goutelle, Sylvain</creator><creator>Sidolle, Elodie</creator><creator>Ducher, Michel</creator><creator>Caron, Jacques</creator><creator>Timour, Quadiri</creator><creator>Nony, Patrice</creator><creator>Gouraud, Aurore</creator><general>Springer International Publishing</general><general>Adis International</general><general>Springer Nature B.V</general><general>Adis</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-1853-2932</orcidid></search><sort><creationdate>20140801</creationdate><title>Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study</title><author>Goutelle, Sylvain ; Sidolle, Elodie ; Ducher, Michel ; Caron, Jacques ; Timour, Quadiri ; Nony, Patrice ; Gouraud, Aurore</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-f1c654124aa41753b0243a639c4f27c9c4e7c8ccadec9a9a3c4244a27eac66633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Anti-Arrhythmia Agents</topic><topic>Anti-Arrhythmia Agents - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Case-Control Studies</topic><topic>Databases, Pharmaceutical</topic><topic>Diuretics</topic><topic>Drug therapy</topic><topic>Female</topic><topic>France</topic><topic>France - epidemiology</topic><topic>Geriatrics</topic><topic>Geriatrics/Gerontology</topic><topic>Health Services for the Aged</topic><topic>Heart</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Life Sciences</topic><topic>Logistic Models</topic><topic>Long QT Syndrome</topic><topic>Long QT Syndrome - chemically induced</topic><topic>Long QT Syndrome - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research Article</topic><topic>Patients</topic><topic>Pharmaceutical sciences</topic><topic>Pharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Pharmacovigilance</topic><topic>Prescription drugs</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Torsades de Pointes</topic><topic>Torsades de Pointes - complications</topic><topic>Torsades de Pointes - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goutelle, Sylvain</creatorcontrib><creatorcontrib>Sidolle, Elodie</creatorcontrib><creatorcontrib>Ducher, Michel</creatorcontrib><creatorcontrib>Caron, Jacques</creatorcontrib><creatorcontrib>Timour, Quadiri</creatorcontrib><creatorcontrib>Nony, Patrice</creatorcontrib><creatorcontrib>Gouraud, Aurore</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Drugs & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goutelle, Sylvain</au><au>Sidolle, Elodie</au><au>Ducher, Michel</au><au>Caron, Jacques</au><au>Timour, Quadiri</au><au>Nony, Patrice</au><au>Gouraud, Aurore</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>31</volume><issue>8</issue><spage>601</spage><epage>609</epage><pages>601-609</pages><issn>1170-229X</issn><eissn>1179-1969</eissn><abstract>Objective
Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS.
Methods
In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP (
n
= 125) and LQTS without TdP (
n
= 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP.
Results
The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms;
p
= 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms.
Conclusion
The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>24923384</pmid><doi>10.1007/s40266-014-0188-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1853-2932</orcidid></addata></record> |
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issn | 1170-229X 1179-1969 |
language | eng |
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source | MEDLINE; Springer Online Journals |
subjects | Aged Anti-Arrhythmia Agents Anti-Arrhythmia Agents - adverse effects Biological and medical sciences Cardiac arrhythmia Cardiac dysrhythmias Cardiology. Vascular system Case-Control Studies Databases, Pharmaceutical Diuretics Drug therapy Female France France - epidemiology Geriatrics Geriatrics/Gerontology Health Services for the Aged Heart Humans Internal Medicine Life Sciences Logistic Models Long QT Syndrome Long QT Syndrome - chemically induced Long QT Syndrome - complications Male Medical sciences Medicine Medicine & Public Health Original Research Article Patients Pharmaceutical sciences Pharmacology Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Pharmacovigilance Prescription drugs Regression analysis Retrospective Studies Risk factors Torsades de Pointes Torsades de Pointes - complications Torsades de Pointes - epidemiology |
title | Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study |
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