title: Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium.
abstract: BACKGROUND
  Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death.
  
  
  OBJECTIVE
  To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk.
  
  
  METHODS
  University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered.
  
  
  METHODS
  Management of the risk of QTc-prolongation.
  
  
  RESULTS
  Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020).
  
  
  CONCLUSIONS
  Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium. Eline.Vandael@pharm.kuleuven.be.
authors.forename: Eline
authors.initials: E
authors.lastname: Vandael
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium.|Department of Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vandenberk
authors.affiliation: Department of Neurosciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium.|Department of Psychiatry, University Hospitals Leuven, 3000, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Vandenberghe
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.|Department of Pharmacy, University Hospitals Leuven, 3000, Leuven, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium.|Department of Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
authors.forename: Veerle
authors.initials: V
authors.lastname: Foulon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001530:Belgium / Q000453:epidemiology; D004562:Electrocardiography / Q000187:drug effects; D005500:Follow-Up Studies; D006220:Haloperidol / Q000009:adverse effects*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D012308:Risk Management / Q000379:methods* / Q000592:standards; D016171:Torsades de Pointes / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol
keywords: Haloperidol; QTc-prolongation; Risk management; Sudden cardiac death; Torsade de Pointes