A Calculated Risk: Evaluation of QTc Drug-Drug Interaction (DDI) Clinical Decision Support (CDS) Alerts and Performance of the Tisdale Risk Score Calculator.

Autor: Wasserman RL; Brigham and Women's Hospital, Boston, MA, USA. rwasserman@bwh.harvard.edu.; MCPHS University, Boston, MA, USA. rwasserman@bwh.harvard.edu., Seger DL; Mass General Brigham, Somerville, MA, USA., Amato MG; Brigham and Women's Hospital, Boston, MA, USA., Hwang AY; Brigham and Women's Hospital, Boston, MA, USA.; MCPHS University, Boston, MA, USA., Fiskio J; Mass General Brigham, Somerville, MA, USA., Bates DW; Brigham and Women's Hospital, Boston, MA, USA.; Mass General Brigham, Somerville, MA, USA.; Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Drug safety [Drug Saf] 2024 Dec; Vol. 47 (12), pp. 1235-1243. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1007/s40264-024-01466-w
Abstrakt: Introduction: A risk factor for a potentially fatal ventricular arrhythmia Torsade de Pointes is a prolongation in the heart rate-corrected QT interval (QTc) ≥ 500 milliseconds (ms) or an increase of ≥ 60 ms from a patient's baseline value, which can cause sudden cardiac death. The Tisdale risk score calculator uses clinical variables to predict which hospitalized patients are at the highest risk for QTc prolongation.
Objective: To determine the rate of overridden QTc drug-drug interaction (DDI)-related clinical decision support (CDS) alerts per patient admission and the prevalence by Tisdale risk score category of these overridden alerts. Secondary outcome was to determine the rate of drug-induced QTc prolongation (diQTP) associated with overrides.
Methods: Our organization's enterprise data warehouse was used to retrospectively access QTc DDI alerts presented for patients aged ≥ 18 years who were admitted to Brigham and Women's Hospital during 2022. The QTc DDI CDS alerts were included if shown to a physician, fellow, resident, physician assistant, or nurse practitioner when entering the order in inpatient areas for patients with a length of stay of at least 2 days. Variables collected for the Tisdale calculator included age, sex, whether patient was on a loop diuretic, potassium level, admission QTc value, admitting diagnosis of acute myocardial infarction, sepsis, or heart failure, and number of QTc-prolonging drugs given to the patient.
Results: A total of 2649 patients with 3033 patient admissions had 18,432 QTc DDI alerts presented that were overridden. An average of 3 unique QTc DDI alerts were presented per patient admission and the alerts were overridden an average of 6 times per patient admission. Overall, 6% of patient admissions were low risk (score ≤ 6), 64% moderate risk (score 7-10), and 30% high risk (score ≥ 11) of QTc prolongation. The most common QTc DDI alerts overridden resulting in an diQTP were quetiapine and propofol (11%) and amiodarone and haloperidol (7%). The diQTP occurred in 883 of patient admissions (29%) and was more frequent in those with higher risk score, with 46% of patient admissions with diQTP in high risk, 23% in moderate risk, and 8% in low risk.
Conclusion: Use of the Tisdale calculator to assess patient-specific risk of QT prolongation combined with CDS may improve overall alert quality and acceptance rate, which may decrease the diQTP rate.
Competing Interests: Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflicts of interest Dr. Bates reports grants and personal fees from EarlySense, personal fees from CDI Negev, equity from ValeraHealth, equity from Clew, equity from MDClone, personal fees and equity from AESOP, personal fees and equity from Feelbetter, equity from Guided Clinical Solutions, and grants from IBM Watson Health, outside the submitted work. Dr. Bates has a patent pending (PHC-028564 US PCT), on intraoperative clinical decision support. Dr. Bates is the Editor-in-Chief of the Journal of Patient Safety. Dr. Bates was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Other authors have no conflict of interest that are relevant to the content of this study. Ethics approval This study was deemed exempt by the Mass General Brigham Institutional Review Board (2023P000243) as the study involved only information collection and analysis of identifiable health information for the purposes of secondary research for which consent is not required. Consent to participate Not applicable. Consent for publication Not applicable. Availability of data and material Data of the study is restricted and cannot be shared openly due to the sensitive protected health information which cannot be anonymized including patient identifiers such as birth dates, admission dates and discharge dates. Code availability Not applicable. Authors contributions All authors contributed to the study conception; design; and acquisition, analysis, or interpretation of the data. RLW, DLS, MGA, and DWB were responsible for study conception or design. RLW, DLS, and JF did the data cleanup and analysis. RLW, MGA, DLS, AYH, and DWB were responsible for the first draft of the manuscript with all authors reviewing the draft and providing critical feedback. All authors contributed to and approved the final manuscript.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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