(111) Evaluation of QT Prolonging Drug Use Among Elderly with Psychiatric Disorders in India using Beers Criteria(2019) and STOPP Criteria(2015)

Background: Psychotropics lengthen electrocardiogram's(ECG) corrected QT(QTc) period. Psychiatric patients exposed to ≥ 1 psychotropic medication have higher likelihood of experiencing drug-activated QTc-prolongation. In older patients(over 60), a longer QTc-interval is associated with increased risk of death from coronary heart disease and all causes combined.

Objectives: The purpose was to analyze frequency of QTc-interval extending risk factors in elderly patients, and appropriateness of QTc-interval protracting medication use.

Methods: This prospective cross-sectional study was conducted using pertinent prescriptions(i.e., the OPD case record forms and treatment sheets) in the Psychiatry OPD at All India Institute of Medical Sciences(AIIMS), Rishikesh, Uttarakhand, India.

Patients were checked for the use of medications that prolong QT. Complete list of medications for each patient was examined for possible interactions, paying close attention to the highly hazardous QT prolonging medications. TdP risks associated with psychotropic and other medications were categorized using the QT drug lists provided by Arizona Center for Education and Research on Therapeutics(AzCERT).

Statistical analyses provided measures of central tendencies and dispersion for continuous data and number of observations and proportions for categorical variables.

Results: Over the course of this study, 832 elderly patients(60 years of age or older) who visited the psychiatry outpatient department(OPD) were examined. Of the patients, 412(49.5%) were female and 420(50.5%) were male. 588(70.7%) of the 832 patients had used interacting agents that could produce TdP. It was possible to unravel nearly 1152 pairs of interacting torsadogenic medications. 1016(48.8%), 724(34.8%), and 248(12%) agents with ability to interact were classified as having "known," "possible," and "conditional risk of TdP," respectively, according to AzCERT/ CredibleMeds Classification. Most frequently occurring interacting drug classes were proton pump inhibitors(364), antipsychotics(340), antidepressants(288), antinausea(184), antimicrobial(156), and H2-receptor antagonists (60). The all-inclusive frequency of potentially inappropriate psychotropic(PIP) agents administered was 62%(1343/2166) with Beers Criteria 2019, and 46%(997/2166) with STOPP Criteria 2015.

Conclusions: Medication and/or combinations with greater proclivity for QT-interval prolongation were given to large number of elderly patients. Selecting right medications with evidence-based online resources can prevent major side effects. In order to prevent QT-extension and TdP in clinical settings, we urgently need to adopt precautionary safety measures, exercise caution, and remain vigilant.