Analysis of Orders for QTc-Prolonging Medication for Intensive and Cardiac Care Unit Patients with Pre-existing QTc Prolongation (QTIPPP Study)
Bibliographic record
Abstract
Background: A prolonged QTc interval on electrocardiography is often used as a surrogate marker for ventricular arrhythmia. Medications that can prolong the QTc interval may increase the risk of cardiac complications, although the exact incidence is unknown. It is reasonable to assume that administration of QTc-prolonging medications to patients with pre-existing QTc prolongation will further increase the risk of cardiac consequences. This study was designed to examine the frequency of prescription of QTc-prolonging medications in such patients and to explore the potential for clinical pharmacists to minimize the associated risks.Objectives: The primary objective was to identify the number of patients with pre-existing prolonged QTc interval for whom QTc-prolonging medications were prescribed, from among all patients with orders for QTc-prolonging medications. The secondary objectives were to determine patterns of intervention by clinical pharmacists in these cases and to document any further QTc prolongation and occurrence of cardiac events.Methods: A prospective, observational, quality assessment study was conducted over 4.5 months. Adult patients admitted to beds with cardiac monitoring by telemetry for whom one or more QTc-prolonging medications were ordered were eligible for inclusion. Patients were included if the QTc interval was longer than 450 ms on the most recent 12-lead electrocardiogram before the QTc-prolonging medication was ordered. These patients were followed to identify outcomes of interest after administration of QTc-prolonging medication.Results: Overall, a QTc-prolonging medication was prescribed for 207 patients. Of these, 53 patients (26%) had pre-existing prolongation of the QTc interval. Clinical pharmacists made recommendations related to 28 medication orders; of these, 16 (57%) were accepted by the physician. Fifty-one (96%) of the 53 patients received at least one dose of QTc-prolonging medication and were monitored daily for complications. Nine (18%) of the 51 patients who underwent daily monitoring experienced at least one cardiac event.Conclusions: A substantial proportion (26%) of patients for whom QTc-prolonging medications were prescribed had pre-existing prolongation of the QTc interval. Clinical pharmacists may have a role in reducing the risk of subsequent complications.RÉSUMÉContexte : Le L’allongement de l’intervalle QTc à l’électrocardiogramme est souvent utilisé comme critère de substitution d’arythmie ventriculaire. Les médicaments pouvant allonger l’intervalle QTc peuvent accroître le risque de complications cardiaques, bien que l’incidence exacte demeure inconnue. On peut raisonnablement prétendre que l’administration de médicaments allongeant l’intervalle QTc chez des patients présentant un allongement préexistant de l’intervalle QTc augmentera le risque de complications cardiaques. Cette étude a été conçue pour examiner la fréquence de prescription de médicaments allongeant l’intervalle QTc chez de tels patients et la possibilité pour les pharmaciens cliniciens de réduire au minimum les risques associés à cette situation.Objectifs : Le principal objectif était de déterminer le nombre de patients présentant un allongement préexistant de l’intervalle QTc à qui l’on a prescrit des médicaments allongeant cet intervalle sur l’ensemble des patients à qui l’on a prescrit des médicaments allongeant l’intervalle QTc. Les objectifs secondaires étaient de déterminer les habitudes d’intervention par les pharmaciens cliniciens dans ces cas et de constater tout allongement supplémentaire de l’intervalle QTc et la survenue d’événements cardiaques.Méthodes : Une étude d’évaluation qualitative, prospective et observationnelle a été menée sur une période de quatre mois. Les patients adultes hospitalisés avec surveillance cardiaque par télémétrie au chevet et à qui l’on prescrivait au moins un médicament allongeant l’intervalle QTc étaient admissibles à l’étude. Les patients étaient admis si l’intervalle QTc objectivé sur le plus récent ECG à 12 dérivations excédait 450 ms avant la prescription de médicaments allongeant l’intervalle QTc. Ces patients ont été suivis afin de déterminer les résultats d’intérêt après l’administration de tels médicaments.Résultats : Dans l’ensemble, on a prescrit un médicament allongeant l’intervalle QTc à 207 patients. De ceux-ci, 53 (26 %) présentaient un allongement préexistant de l’intervalle QTc. Les pharmaciens cliniciens ont formulé des recommandations liées à 28 des prescriptions de ces médicaments; de ces recommandations, 16 (57 %) ont été acceptées par le médecin. De plus, 51 (96 %) des 53 patients ont reçu au moins une dose de médicament allongeant l’intervalle QTc et ont fait l’objet d’une surveillance quotidienne des complications. Neuf (18%) de ces 51 patients ont présenté au moins un événement cardiaque.Conclusions : Une proportion considérable (26 %) des patients à qui l’on a prescrit un médicament allongeant l’intervalle QTc présentait un allongement préexistant de cet intervalle, ce qui porte à croire que les pharmaciens cliniciens pourraient avoir un rôle à jouer dans la réduction du risque de complications subséquentes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".