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

C. Franchi, I. Ardoino, R. Rossio, A. Nobili, E. M. Biganzoli, A. Marengoni, M. Marcucci, L. Pasina, M. Tettamanti, S. Corrao, P. M. Mannucci

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalDrugs and Aging
Volume33
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Pharmaceutical Preparations
Odds Ratio
Torsades de Pointes
Therapeutic Human Experimentation
Education
Hypokalemia
Amiodarone
Furosemide
Drug Combinations
Medical Students
Curriculum
Atrial Fibrillation
Prescriptions
Registries
Comorbidity
Heart Failure
Logistic Models
Physicians

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People. / Franchi, C.; Ardoino, I.; Rossio, R.; Nobili, A.; Biganzoli, E. M.; Marengoni, A.; Marcucci, M.; Pasina, L.; Tettamanti, M.; Corrao, S.; Mannucci, P. M.

In: Drugs and Aging, Vol. 33, No. 1, 01.01.2016, p. 53-61.

Research output: Contribution to journalArticle

@article{3b8ddacc4fe84cf7adfeec0574bd2913,
title = "Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People",
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 [Societ{\`a} 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.",
author = "C. Franchi and I. Ardoino and R. Rossio and A. Nobili and Biganzoli, {E. M.} and A. Marengoni and M. Marcucci and L. Pasina and M. Tettamanti and S. Corrao and Mannucci, {P. M.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1007/s40266-015-0337-y",
language = "English",
volume = "33",
pages = "53--61",
journal = "Drugs and Aging",
issn = "1170-229X",
publisher = "Springer International Publishing",
number = "1",

}

TY - JOUR

T1 - Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People

AU - Franchi, C.

AU - Ardoino, I.

AU - Rossio, R.

AU - Nobili, A.

AU - Biganzoli, E. M.

AU - Marengoni, A.

AU - Marcucci, M.

AU - Pasina, L.

AU - Tettamanti, M.

AU - Corrao, S.

AU - Mannucci, P. M.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84953835605&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953835605&partnerID=8YFLogxK

U2 - 10.1007/s40266-015-0337-y

DO - 10.1007/s40266-015-0337-y

M3 - Article

VL - 33

SP - 53

EP - 61

JO - Drugs and Aging

JF - Drugs and Aging

SN - 1170-229X

IS - 1

ER -