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

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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.

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Author contributions

Study concept and design: Carlotta Franchi, Ilaria Ardoino. Acquisition, analysis, or interpretation of data: Carlotta Franchi, Ilaria Ardoino. Drafting of the manuscript: Carlotta Franchi, Ilaria Ardoino. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Ilaria Ardoino. Study supervision: Carlotta Franchi, Pier Mannuccio Mannucci, Alessandro Nobili.

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Author notes

    Authors and Affiliations

    1. Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

      C. Franchi, A. Nobili, L. Pasina & M. Tettamanti

    2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

      I. Ardoino, E. M. Biganzoli & M. Marcucci

    3. Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda–Ospedale Maggiore Policlinico, Milan, Italy

      R. Rossio

    4. Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy

      A. Marengoni

    5. Geriatrics Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy

      M. Marcucci

    6. Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy

      S. Corrao

    7. A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy

      P. M. Mannucci

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    Consortia

    The REPOSI Investigators

    Corresponding author

    Correspondence to C. Franchi.

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    Funding

    No funding was received for the conduct of this study or preparation of this manuscript.

    Conflict of interest

    C Franchi, I Ardoino, R Rossio, A Nobili, E M. Biganzoli, A Marengoni, M Marcucci, L Pasina, M Tettamanti, S Corrao, P M Mannucci declare that they have no conflict of interest.

    Additional information

    C. Franchi and I. Ardoino contributed equally to this work.

    REPOSI denotes the REgistro POliterapie SIMI (Società Italiana di Medicina Interna); the full list of contributors is available online as Electronic Supplementary Material.

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    Cite this article

    Franchi, C., Ardoino, I., Rossio, R. et al. Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People. Drugs Aging 33, 53–61 (2016). https://doi.org/10.1007/s40266-015-0337-y

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