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Are ECG monitoring recommendations before prescription of QT‐prolonging drugs applied in daily practice? The example of haloperidol
Author(s) -
Warnier Miriam Jacoba,
Rutten Frans Hendrik,
Souverein Patrick Cyriel,
Boer Anthonius,
Hoes Arno Wilhelmus,
De Bruin Marie Louise
Publication year - 2015
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.3792
Subject(s) - medicine , haloperidol , medical prescription , qt interval , logistic regression , electrocardiography , pharmacoepidemiology , emergency medicine , anesthesia , pharmacology , dopamine
Abstract Purpose Monitoring of the QT duration by electrocardiography (ECG) prior to treatment is frequently recommended in the label of QT‐prolonging drugs. It is, however, unknown how often general practitioners in daily clinical practice are adhering to these risk‐minimization measures. We assessed the frequency of ECG measurements in patients where haloperidol was initiated in primary care. Methods Patients (≥18 years) with a first prescription of haloperidol in the UK Clinical Practice Research Datalink (2009–2013) were included. The proportion of ECGs made was determined in two blocks of 4 weeks: during the exposure period when haloperidol was initiated, and during the control period, 1 year before. Conditional logistic regression analysis was applied to calculate the relative risk of having an ECG in the exposure period compared with the control period. Subgroup analyses were performed to assess the proportion of ECG measurements in patients with one or more additional risk factors for QT prolongation. Results In total, 3420 patients were prescribed haloperidol during the exposure period, and 1.8% of them had an ECG at treatment initiation, compared with 0.8% during the control period (relative risk [RR] 2.4 [1.5–3.8]). Of the patients with additional risk factors for QT prolongation, 1.9% of the patients had an ECG at initiation of the prescription, compared with 1.0% during the control period (RR 2.1 [1.2–3.5]). Conclusions Compliance with recommendations to perform an electrocardiogram when starting a new QT‐prolonging drug is extremely low, when haloperidol is taken as an example. Copyright © 2015 John Wiley & Sons, Ltd.