title: Frequency of electrocardiogram testing among HIV-infected patients at risk for medication-induced QTc prolongation.
abstract: OBJECTIVE
  HIV-infected patients are commonly prescribed several medications and are thus at risk for drug interactions that may result in QTc prolongation. We sought (1) to identify the frequency of electrocardiogram (ECG) monitoring (2), to determine the prevalence of drug interactions involving QTc-prolonging medications, and (3) to quantify the prevalence of QTc prolongation.
  
  
  METHODS
  A cross-sectional study was conducted among HIV-infected adults. Demographics, medications, drug interactions and comorbidities were abstracted from patients' medical records. Abnormal QTc interval was defined per the UK Committee for Proprietary Medicinal Products. Clinical characteristics were compared among ECG recipients and nonrecipients. Among ECG recipients, the prevalence and predictors of QTc prolongation were assessed.
  
  
  RESULTS
  Among the 454 patients included in the study, 80.8% were prescribed a medication associated with QTc prolongation and 39% had drug interactions expected to increase QTc prolongation risk. There were 138 patients (30.3%) who received ECG testing. Receipt of ECG monitoring was associated with increasing age, diabetes, increasing total number of medications and gastroesophageal reflux disease. Among ECG recipients, the prevalence of abnormal QTc interval was 27.5%. Chronic kidney disease [prevalence ratio (PR) 3.47; 95% confidence interval (CI) 1.37-8.83; P = 0.009], hepatitis C virus coinfection (PR 2.26; 95% CI 0.97-5.27; P = 0.06) and hypertension (PR 2.11; 95% CI 0.93-4.81; P = 0.07) were independently associated with an abnormal QTc interval.
  
  
  CONCLUSIONS
  A low frequency of ECG testing was observed, despite a high use of medications associated with QTc prolongation. The risk of abnormal QTc interval was highest among patients with chronic kidney disease, hypertension and hepatitis C virus coinfection.
authors.affiliation: Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: Veve
authors.forename: S
authors.initials: S
authors.lastname: Kwon
authors.forename: L-A
authors.initials: LA
authors.lastname: McNutt
authors.forename: D
authors.initials: D
authors.lastname: Fish
authors.forename: C D
authors.initials: CD
authors.lastname: Miller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D004347:Drug Interactions / Q000502:physiology*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D005764:Gastroesophageal Reflux; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology; D016174:Hepacivirus; D006801:Humans; D006973:Hypertension; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic; D012307:Risk Factors; D016171:Torsades de Pointes / Q000453:epidemiology; D055815:Young Adult
keywords: QTc prolongation; drug interactions; electrocardiogram