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Use of QT‐prolonging medications in US emergency departments, 1995–2009
Author(s) -
Tay KhoonYen,
Ewald Michele Burns,
Bourgeois Florence T.
Publication year - 2014
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3455
Subject(s) - medicine , medical prescription , qt interval , emergency department , emergency medicine , long qt syndrome , diphenhydramine , ambulatory , pharmacology , psychiatry , histamine
Purpose Emergency department (ED) patients receive medications that place them at risk for adverse events, including drug‐induced prolongation of the QT interval, which can lead to Torsade de Pointes and sudden cardiac death. We report the frequency of prescription and co‐prescription of QT‐prolonging medications in US EDs and factors associated with high‐risk prescribing practices. Methods We analyzed the ED component of the National Hospital Ambulatory Medical Care Survey for 1995 through 2009. Yearly rates of visits involving the prescription of QT‐prolonging medications were determined. Multivariate regression analyses identified factors associated with the prescription of two or more QT‐prolonging medications. Results Approximately 16.5 million visits annually (15.0%) involved prescription of a QT‐prolonging drug, with 1.7 million (1.6%) involving multiple prescriptions. Visits associated with QT‐prolonging drugs more than doubled over the study period (10.4% to 22.2%). Diphenhydramine, azithromycin, and ondansetron were most frequently implicated (46.1% of cases). The most commonly prescribed combination was diphenhydramine and famotidine, both QT‐prolonging medications available over‐the‐counter. Female gender and older age were associated with co‐prescription of QT‐prolonging medications. The rate of EKG screening among visits associated with QT‐prolonging drug combinations was low (20.9%), but more common than among visits without a QT‐prolonging drug (OR 1.3; 95% CI 1.2–1.5). Conclusion Use of QT‐prolonging medications is increasing in EDs nationally. A small number of agents account for a large proportion of these visits and may represent an area for targeted screening or monitoring interventions in the ED. Copyright © 2013 John Wiley & Sons, Ltd.