Clinically relevant QTc prolongation due to overridden drug-drug interaction alerts: A retrospective cohort study
AIMS: To investigate whether, in patients in whom drug-drug interaction (DDI) alerts on QTc prolongation were overridden, the physician had requested an electrocardiogram (ECG), and if these ECGs showed clinically relevant QTc prolongation. METHODS: For all patients with overridden DDI alerts on QTc prolongation during 6 months, data on risk factors for QT prolongation, drug class and ECGs were collected from the medical record. Patients with ventricular pacemakers, patients treated on an outpatient basis, and patients using the low-risk combination of cotrimoxazole and tacrolimus were excluded. The magnitude of the effect on the QTc interval was calculated if ECGs before and after overriding were available. Changes of the QTc interval in these cases were compared with those of a control group using one QTc-prolonging drug. RESULTS: In 33% of all patients with overridden QTc alerts an ECG was recorded within 1 month. ECGs were more often recorded in patients with more risk factors for QTc prolongation and with more QTc overrides. ECGs before and after the QTc override were available in 29% of patients. Thirty-one percent of patients in this group showed clinically relevant QTc prolongation with increased risk of torsades de pointes or ventricular arrhythmias. The average change in QTc interval was +31 ms for cases and -4 ms for controls. CONCLUSIONS: Overriding the high-level DDI alerts on QTc prolongation rarely resulted in the preferred approach to subsequently record an ECG. If ECGs were recorded before and after QTc overrides, clinically relevant QTc prolongation was found in one-third of cases. ECG recording after overriding QTc alerts should be encouraged to prevent adverse events.
|Keywords||Alert override, Computer assisted, Computerized physician order entry, Drug therapy, Error management, Patient safety, QT prolongation, QTc-prolongation, adult, aged, amiodarone, article, beta adrenergic receptor blocking agent, calcium channel blocking agent, chlorpromazine, cisapride, clarithromycin, cohort analysis, computer program, computerized physician order entry, cotrimoxazole; digoxin, decision support system, diuretic agent, domperidone, drug drug interaction alert, electrocardiogram, electronic medical record, erythromycin, female, haloperidol, heart ventricle arrhythmia, human, indapamide, ketanserin, low drug dose, major clinical study, male, medical decision making, medical record review, mianserin, nitrate, pentamidine, priority journal, promethazine, retrospective study, risk factor, sotalol, tacrolimus, torsade des pointes|
|Persistent URL||dx.doi.org/10.1111/j.1365-2125.2008.03357.x, hdl.handle.net/1765/16595|
|Journal||British Journal of Clinical Pharmacology|
van der Sijs, I.H, Kowlesar, R, Klootwijk, A.P.J, Nelwan, S.P, Vulto, A.G, & van Gelder, T. (2009). Clinically relevant QTc prolongation due to overridden drug-drug interaction alerts: A retrospective cohort study. British Journal of Clinical Pharmacology, 67(3), 347–354. doi:10.1111/j.1365-2125.2008.03357.x