Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People
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 SI...
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| Veröffentlicht in: | Drugs & aging 2016-01, Vol.33 (1), p.53-61 |
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| creator | Franchi, C. Ardoino, I. Rossio, R. Nobili, A. Biganzoli, E. M. Marengoni, A. Marcucci, M. Pasina, L. Tettamanti, M. Corrao, S. Mannucci, P. M. |
| 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. |
| doi_str_mv | 10.1007/s40266-015-0337-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1760883356</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1760883356</sourcerecordid><originalsourceid>FETCH-LOGICAL-c485t-de1f2ff56f9bbc4896b9ec4cbbf197a84c739560ac23c6c9a14e3e1c1c38df263</originalsourceid><addsrcrecordid>eNp1kU9v1DAQxS0EoqXwAXpBlrj0YvDYiRMfq_6hSJW6Ra3EzXKc8dZtNt7aCWj59Hi7BSEkTjMa_94bax4hh8A_AufNp1xxoRTjUDMuZcM2L8g-QKMZaKVfPvWcCaG_7ZE3Od9zzpUQ8JrsFZWWWsA-cYuE3-2Ao0Nqx55-DfmBnls3xZTpcc7RBTthT3-E6Y7eZqTR0-sbtkhxiOMyjEt6muZlpmGkFzGvw2SH8LPwV0OPiS4wrgd8S155O2R891wPyO352c3JBbu8-vzl5PiSuaqtJ9YjeOF9rbzuujLSqtPoKtd1HnRj28o1UteKWyekU05bqFAiOHCy7b1Q8oAc7XzXKT7OmCezCtnhMNgR45wNNIq3rZT1Fv3wD3of5zSW3xWqhVZAWzeFgh3lUsw5oTfrFFY2bQxws03A7BIwJQGzTcBsiub9s_PcrbD_o_h98gKIHZDL07jE9Nfq_7r-AqwKkcM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781821857</pqid></control><display><type>article</type><title>Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Franchi, C. ; Ardoino, I. ; Rossio, R. ; Nobili, A. ; Biganzoli, E. M. ; Marengoni, A. ; Marcucci, M. ; Pasina, L. ; Tettamanti, M. ; Corrao, S. ; Mannucci, P. M.</creator><creatorcontrib>Franchi, C. ; Ardoino, I. ; Rossio, R. ; Nobili, A. ; Biganzoli, E. M. ; Marengoni, A. ; Marcucci, M. ; Pasina, L. ; Tettamanti, M. ; Corrao, S. ; Mannucci, P. M. ; REPOSI Investigators ; The REPOSI Investigators</creatorcontrib><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.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-015-0337-y</identifier><identifier>PMID: 26693921</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Aged, 80 and over ; Amiodarone - adverse effects ; Atrial Fibrillation - complications ; Electrocardiography ; Female ; Geriatrics/Gerontology ; Hospitalization ; Humans ; Internal Medicine ; Long QT Syndrome - epidemiology ; Long QT Syndrome - etiology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Research Article ; Patient Discharge ; Pharmacology/Toxicology ; Pharmacotherapy ; Prevalence ; Risk Factors ; Torsades de Pointes - epidemiology ; Torsades de Pointes - etiology</subject><ispartof>Drugs & aging, 2016-01, Vol.33 (1), p.53-61</ispartof><rights>Springer International Publishing Switzerland 2015</rights><rights>Copyright Springer Science & Business Media Jan 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c485t-de1f2ff56f9bbc4896b9ec4cbbf197a84c739560ac23c6c9a14e3e1c1c38df263</citedby><cites>FETCH-LOGICAL-c485t-de1f2ff56f9bbc4896b9ec4cbbf197a84c739560ac23c6c9a14e3e1c1c38df263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-015-0337-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-015-0337-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26693921$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Franchi, C.</creatorcontrib><creatorcontrib>Ardoino, I.</creatorcontrib><creatorcontrib>Rossio, R.</creatorcontrib><creatorcontrib>Nobili, A.</creatorcontrib><creatorcontrib>Biganzoli, E. M.</creatorcontrib><creatorcontrib>Marengoni, A.</creatorcontrib><creatorcontrib>Marcucci, M.</creatorcontrib><creatorcontrib>Pasina, L.</creatorcontrib><creatorcontrib>Tettamanti, M.</creatorcontrib><creatorcontrib>Corrao, S.</creatorcontrib><creatorcontrib>Mannucci, P. M.</creatorcontrib><creatorcontrib>REPOSI Investigators</creatorcontrib><creatorcontrib>The REPOSI Investigators</creatorcontrib><title>Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amiodarone - adverse effects</subject><subject>Atrial Fibrillation - complications</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Geriatrics/Gerontology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Long QT Syndrome - epidemiology</subject><subject>Long QT Syndrome - etiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Research Article</subject><subject>Patient Discharge</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Prevalence</subject><subject>Risk Factors</subject><subject>Torsades de Pointes - epidemiology</subject><subject>Torsades de Pointes - etiology</subject><issn>1170-229X</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU9v1DAQxS0EoqXwAXpBlrj0YvDYiRMfq_6hSJW6Ra3EzXKc8dZtNt7aCWj59Hi7BSEkTjMa_94bax4hh8A_AufNp1xxoRTjUDMuZcM2L8g-QKMZaKVfPvWcCaG_7ZE3Od9zzpUQ8JrsFZWWWsA-cYuE3-2Ao0Nqx55-DfmBnls3xZTpcc7RBTthT3-E6Y7eZqTR0-sbtkhxiOMyjEt6muZlpmGkFzGvw2SH8LPwV0OPiS4wrgd8S155O2R891wPyO352c3JBbu8-vzl5PiSuaqtJ9YjeOF9rbzuujLSqtPoKtd1HnRj28o1UteKWyekU05bqFAiOHCy7b1Q8oAc7XzXKT7OmCezCtnhMNgR45wNNIq3rZT1Fv3wD3of5zSW3xWqhVZAWzeFgh3lUsw5oTfrFFY2bQxws03A7BIwJQGzTcBsiub9s_PcrbD_o_h98gKIHZDL07jE9Nfq_7r-AqwKkcM</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Franchi, C.</creator><creator>Ardoino, I.</creator><creator>Rossio, R.</creator><creator>Nobili, A.</creator><creator>Biganzoli, E. M.</creator><creator>Marengoni, A.</creator><creator>Marcucci, M.</creator><creator>Pasina, L.</creator><creator>Tettamanti, M.</creator><creator>Corrao, S.</creator><creator>Mannucci, P. M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><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>7X8</scope></search><sort><creationdate>20160101</creationdate><title>Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People</title><author>Franchi, C. ; Ardoino, I. ; Rossio, R. ; Nobili, A. ; Biganzoli, E. M. ; Marengoni, A. ; Marcucci, M. ; Pasina, L. ; Tettamanti, M. ; Corrao, S. ; Mannucci, P. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c485t-de1f2ff56f9bbc4896b9ec4cbbf197a84c739560ac23c6c9a14e3e1c1c38df263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amiodarone - adverse effects</topic><topic>Atrial Fibrillation - complications</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Geriatrics/Gerontology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Long QT Syndrome - epidemiology</topic><topic>Long QT Syndrome - etiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Research Article</topic><topic>Patient Discharge</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Prevalence</topic><topic>Risk Factors</topic><topic>Torsades de Pointes - epidemiology</topic><topic>Torsades de Pointes - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Franchi, C.</creatorcontrib><creatorcontrib>Ardoino, I.</creatorcontrib><creatorcontrib>Rossio, R.</creatorcontrib><creatorcontrib>Nobili, A.</creatorcontrib><creatorcontrib>Biganzoli, E. M.</creatorcontrib><creatorcontrib>Marengoni, A.</creatorcontrib><creatorcontrib>Marcucci, M.</creatorcontrib><creatorcontrib>Pasina, L.</creatorcontrib><creatorcontrib>Tettamanti, M.</creatorcontrib><creatorcontrib>Corrao, S.</creatorcontrib><creatorcontrib>Mannucci, P. M.</creatorcontrib><creatorcontrib>REPOSI Investigators</creatorcontrib><creatorcontrib>The REPOSI Investigators</creatorcontrib><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>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</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 Edition)</collection><collection>ProQuest Central UK/Ireland</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>Medical Database</collection><collection>ProQuest Psychology</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>MEDLINE - Academic</collection><jtitle>Drugs & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Franchi, C.</au><au>Ardoino, I.</au><au>Rossio, R.</au><au>Nobili, A.</au><au>Biganzoli, E. M.</au><au>Marengoni, A.</au><au>Marcucci, M.</au><au>Pasina, L.</au><au>Tettamanti, M.</au><au>Corrao, S.</au><au>Mannucci, P. M.</au><aucorp>REPOSI Investigators</aucorp><aucorp>The REPOSI Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>33</volume><issue>1</issue><spage>53</spage><epage>61</epage><pages>53-61</pages><issn>1170-229X</issn><eissn>1179-1969</eissn><abstract>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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>26693921</pmid><doi>10.1007/s40266-015-0337-y</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1170-229X |
| ispartof | Drugs & aging, 2016-01, Vol.33 (1), p.53-61 |
| issn | 1170-229X 1179-1969 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Aged, 80 and over Amiodarone - adverse effects Atrial Fibrillation - complications Electrocardiography Female Geriatrics/Gerontology Hospitalization Humans Internal Medicine Long QT Syndrome - epidemiology Long QT Syndrome - etiology Male Medicine Medicine & Public Health Middle Aged Original Research Article Patient Discharge Pharmacology/Toxicology Pharmacotherapy Prevalence Risk Factors Torsades de Pointes - epidemiology Torsades de Pointes - etiology |
| title | Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People |
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