Franjic, Lucy

Halcomb, S. Eliza

House, Stacey

Vitkovitsky, Irena

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Washington University School of MedicineDigital Commons@BeckerConference Abstracts and Posters Division of Emergency Medicine/Emergency CareResearch Section2012Administration of QTc prolonging medications inemergency department patients with prolongedQTcLucy FranjicWashington University School of Medicine in St. LouisStacey HouseWashington University School of Medicine in St. LouisIrena VitkovitskyWashington University School of Medicine in St. LouisS. Eliza HalcombWashington University School of Medicine in St. LouisFollow this and additional works at: http://digitalcommons.wustl.edu/em_confThis Presentation Paper is brought to you for free and open access by the Division of Emergency Medicine/Emergency Care Research Section atDigital Commons@Becker. It has been accepted for inclusion in Conference Abstracts and Posters by an authorized administrator of DigitalCommons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationFranjic, Lucy; House, Stacey; Vitkovitsky, Irena; Halcomb, S. Eliza, "Administration of QTc prolonging medications in emergencydepartment patients with prolonged QTc" (2012). Conference Abstracts and Posters. Paper 14. http://digitalcommons.wustl.edu/em_conf/14Administration of QTc Prolonging Medications in  Emergency Department Patients with Prolonged QTc Stacey L. House MD PhD, Lucy Franjic MD, Irena Vitkovitsky MD, S. Eliza Halcomb MD  Washington University in St. Louis Division of Emergency Medicine Lucy Franjic, MD Society for Academic Emergency Medicine Great Plains Regional Research Forum  St. Louis, MO. September 2012 © Stacey House, 2012  QTc prolongation is associated with fatal arrhythmias including torsades de pointes (TdP) and sudden cardiac death  Many medications given in the ED prolong QTc thus recognition of QTc prolongation may alter medication choice  BACKGROUND Retrospective chart review of all ED patients who received an ECG for any reason during the 5 month period of June 2009 – October 2009 at a large volume, tertiary care center.  Inclusion Criteria:  Patients with a computer generated QTc ≥ 460 ms.  Exclusion Criteria: Bradycardia (HR < 60 bpm)    Tachycardia (HR > 100 bpm)    QRS > 120 ms    Non-sinus or paced rhythm    Patients who left without being seen or against medical advice  ED electronic medical records were reviewed for medications administered in the ED. QTc prolonging medications were defined as those listed by the Arizona Center for Education and Research on Therapeutics (AzCERT) and were classified as Class 1 (causes TdP), Class 2 (prolong QTc and reported to cause TdP), and Class 3 (prolong QTc and could cause TdP) as defined by AzCERT  Statistical Analysis - Data is expressed as proportion ± 95% confidence intervals.  Data was compared among groups using a Chi-squared test.  Methods 2402 pts (20%) QTc ≥ 460 ms 11,359 Patients 8957 pts (80%) Normal QTc 1084 pts (45%) Eligible 1318 pts (55%) Excluded 615 pts (57%) QTc 460-479 274 pts (25%) QTc 480-499 195 pts (18%) QTc 500+ 5.4% % of all pts 2.4% 1.7% Excluded Patients QRS > 120 ms 559 pts Tachycardia  581 pts Bradycardia  151 pts Non-sinus rhythm 239 pts Paced rhythm 182 pts LWBS or AMA   27 pts RESULTS Drug Classes Administered  020406080100120140# Patients Receiving Med Medications Received 00.050.10.150.20.250.30.350.40.45Any Med Class 3 Class 2 Class 1 >1 MedProportion Present 460-479 ms480-499 ms500+ ms* *p<0.01 00.10.20.30.40.50.60.70.8Discharge Admit Without Telemetry Admit With TelemetryProportion Present 460-479 ms480-499 ms500+ msPatient Disposition   Administration of QTc prolonging medications is common in ED patients with prolonged QTc  Patients with the most prolonged QTc were at highest risk of receiving multiple QTc prolonging medications  Further studies needed to determine if the administration of QTc prolonging medications in patients with prolonged QTc increases the risk of cardiac dysrhythmias  Conclusion  Golzari, H. “Prolonged QTc intervals on admission electrocardiograms: prevalence and correspondence with admission electrolyte abnormalities.” Connecticut Medicine. 7 (2007): 389-97.  Schulman M. “Hypokalemia and cardiovascular disease.” American Journal of Cardiology. 65 (1990): 4E-9E.  Seftchick, Michael. “The prevalence and factors associated with QTc prolongation among emergency department patients.” Annals of Emergency Medicine. 54 (2009). 763-768.  Taylor, D. “Cocaine induced prolongation of the QT interval.” Emergency Medicine Journal. 21 (2004): 252-253.  Bibliography 

Administration of QTc prolonging medications in emergency department patients with prolonged QTc

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Administration of QTc prolonging medications in emergency department patients with prolonged QTc

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