Dataset Information

Association of QT-Prolonging Medications With Risk of Autopsy-Defined Causes of Sudden Death.

ABSTRACT:

Importance

QT-prolonging medications (QTPMs) are a reported risk factor for sudden cardiac death (SCD) when defined by consensus criteria that presume an arrhythmic cause. The effect of QTPM on autopsy-defined sudden arrhythmic death (SAD) is unknown.

Objective

To evaluate the association between QTPM and autopsy-defined SAD vs nonarrhythmic cause of sudden death.

Design, setting, and participants

This prospective countywide case-control study included World Health Organization-defined (presumed) SCD cases who underwent autopsy as part of the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study (POST SCD) to determine arrhythmic or nonarrhythmic cause, and control deaths due to trauma (hereinafter referred to as trauma controls) in San Francisco County, California, from February 1, 2011, to March 1, 2014. Multivariate regression was used to evaluate the association of QTPM with the risk of presumed SCD, autopsy-defined SAD, and non-SAD compared with trauma controls. Medication exposure, determined by prescription lists and postmortem toxicologic findings, was used to calculate a summative QTPM exposure score (range, 0-20). Data were analyzed from September 1, 2018, to June 15, 2019.

Exposure

QT-prolonging medication exposure, as measured by QTPM score (1 indicated low; 2-4, moderate; and >4, high).

Main outcomes and measures

Death due to trauma, presumed SCD, and autopsy-defined non-SAD and SAD with no postmortem findings of extracardiac cause.

Results

A total of 629 patients (mean [SD] age, 61.4 [15.7] years; 439 men [69.8%]) were included, 525 with presumed SCDs and 104 traumatic death controls. Individuals with presumed SCDs had higher exposure and were more likely to be taking any QTPM (291 [55.4%] vs 28 [26.9%]; P?Conclusions and relevanceThese findings confirm the association between QTPMs and presumed SCD; however, after autopsy, this risk was specific for nonarrhythmic causes of sudden death. Studies using consensus SCD criteria may overestimate the association of QTPMs with the risk of SAD.

SUBMITTER: Simpson TF

PROVIDER: S-EPMC7052791 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Publications

Association of QT-Prolonging Medications With Risk of Autopsy-Defined Causes of Sudden Death.

Simpson Timothy F TF Salazar James W JW Vittinghoff Eric E Probert Joanne J Iwahashi Alan A Olgin Jeffrey E JE Ursell Phillip P Hart Amy A Moffatt Ellen E Tseng Zian H ZH

JAMA internal medicine 20200501 5

<h4>Importance</h4>QT-prolonging medications (QTPMs) are a reported risk factor for sudden cardiac death (SCD) when defined by consensus criteria that presume an arrhythmic cause. The effect of QTPM on autopsy-defined sudden arrhythmic death (SAD) is unknown.<h4>Objective</h4>To evaluate the association between QTPM and autopsy-defined SAD vs nonarrhythmic cause of sudden death.<h4>Design, setting, and participants</h4>This prospective countywide case-control study included World Health Organiza ...[more]

PMID: 32119028

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Project description:Background and objectivesSeveral drugs used in CKD can prolong electrocardiographic conduction. We examined the use of electrocardiogram QT-prolonging medications in predialysis CKD and their association with QT duration.Design, setting, participants, & measurementsIn total, 3252 Chronic Renal Insufficiency Cohort participants with at least one study electrocardiogram between 2003 and 2011 were included. QT-prolonging medications used in 100 or more visits (n=16,451 visits) along with diuretics and proton pump inhibitors, given their potential for electrolyte disturbances, were examined for QT interval prolongation.ResultsMean QT interval corrected for heart rate was at 414±21 (±SD) milliseconds and prolonged (≥450 milliseconds) in 4.6% of electrocardiograms. QT interval corrected for heart rate was inversely related to serum potassium and calcium. Medications classified as QT prolonging were taken at 76% of visits, with two or more of these taken at 33% of visits. Of 30 medications examined, eight were associated with statistically significant QT interval corrected for heart rate prolongation after adjustment for comorbidities, potassium, and calcium, including amiodarone (+10±2 milliseconds), metolazone (+7±2 milliseconds), fluoxetine (+4±1 milliseconds), citalopram (+4±1 milliseconds), hydroxyzine (+4±1 milliseconds), escitalopram (+3±2 milliseconds), venlafaxine (+3±1 milliseconds), and furosemide (+3±0 milliseconds). Potassium-depleting diuretics were associated with minimal decrements in potassium (between 0.1 and 0.3 mEq/L) and smaller changes in calcium. Diuretics associated with a change in QT interval corrected for heart rate before adjustment for potassium and calcium were metolazone (+8±3 milliseconds), furosemide (+4±1 milliseconds), and spironolactone (-3±3 milliseconds). Most of the QT prolongation associated with metolazone and furosemide, but not spironolactone, remained after adjustment for potassium and calcium. Proton pump inhibitors were not associated with QT prolongation.ConclusionsUse of medications associated with QT prolongation is common in CKD; the safety implications of these findings should be considered in these high-risk patients.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_08_09_CJASNPodcast_17_09_b.mp3.

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Dataset Information

Association of QT-Prolonging Medications With Risk of Autopsy-Defined Causes of Sudden Death.

Importance

Objective

Design, setting, and participants

Exposure

Main outcomes and measures

Results

Publications

Association of QT-Prolonging Medications With Risk of Autopsy-Defined Causes of Sudden Death.

Similar Datasets

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