title: Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People.
abstract: OBJECTIVE
  The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older).
  
  
  METHODS
  Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed.
  
  
  RESULTS
  Among 3906 patients prescribed at least one drug at admission, 2156 (55.2%) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95% CI 1.01-1.03), multimorbidity (OR 2.69, 95% CI 2.33-3.10), hypokalemia (OR 2.79, 95% CI 1.32-5.89), atrial fibrillation (OR 1.66, 95% CI 1.40-1.98), and heart failure (OR 3.17, 95% CI 2.49-4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8% were prescribed them at discharge.
  
  
  CONCLUSIONS
  Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.
authors.affiliation: Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. carlotta.franchi@marionegri.it.
authors.forename: C
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Ardoino
authors.affiliation: Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Rossio
authors.affiliation: Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nobili
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: E M
authors.initials: EM
authors.lastname: Biganzoli
authors.affiliation: Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.|Geriatrics Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Marcucci
authors.affiliation: Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Corrao
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: P M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008133:Long QT Syndrome / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015995:Prevalence; D012307:Risk Factors; D016171:Torsades de Pointes / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000638:Amiodarone