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

NCBINCBI Logo Skip to main content Skip to navigation Resources How To About NCBI Accesskeys PubMed US National Library of Medicine National Institutes of Health Search database Search term Clear input Advanced Help Result Filters Format: Abstract Send to Drugs Aging. 2016 Jan;33(1):53-61. doi: 10.1007/s40266-015-0337-y. Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People. Franchi C1, Ardoino I2, Rossio R3, Nobili A4, Biganzoli EM2, Marengoni A5, Marcucci M2,6, Pasina L4, Tettamanti M4, Corrao S7, Mannucci PM8; REPOSI Investigators. Collaborators (320) Author information 1 Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. carlotta.franchi@marionegri.it. 2 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 3 Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. 4 Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. 5 Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy. 6 Geriatrics Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. 7 Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy. 8 A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. 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.