Journal article
QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry
Journal of psychosomatic research, Vol.135, pp.110138-110138
08/2020
DOI: 10.1016/j.jpsychores.2020.110138
PMID: 32442893
Abstract
Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments.
After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval. A risk score was developed based on risk factors for QTc prolongation to guide clinical decision-making.
A baseline ECG may not be necessary for individuals at low risk for arrythmia. Those individuals with a risk score of two or more should have an ECG prior to the start of a potentially QTc-prolonging medication or be started on a lower risk agent. Antipsychotics are not equivalent in causing QTc prolongation. A consensus-based algorithm is presented for the management of those identified at high (QTc >500 msec), intermediate (males with QTc 450-499 msec or females with QTc > 470-499 msec), or low risk.
The proposed algorithm can help clinicians in determining whether ECG monitoring should be considered for a given patient. These guidelines preserve a role for clinical judgment in selection of treatments that balance the risks and benefits, which may be particularly relevant for complex patients with medical and psychiatric comorbidities. Additional studies are needed to determine whether baseline and serial ECG monitoring reduces mortality.
Details
- Title: Subtitle
- QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry
- Creators
- Glen L Xiong - Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, CA, United States of America. Electronic address: gxiong@ucdavis.eduAaron Pinkhasov - Department of Behavioral Health, NYU Winthrop Hospital, Mineola, NY, United States of AmericaJed P Mangal - Department of Behavioral Health, Martin Army Community Hospital, Ft Benning, GA, United States of AmericaHeather Huang - Departments of Psychiatry and Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of AmericaJeffrey Rado - Psychiatry and General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of AmericaJane Gagliardi - Departments of Psychiatry and Behavioral Sciences, and Internal Medicine, Duke University School of Medicine, Durham, NC, United States of AmericaDustin Demoss - Department of Psychiatry, University of North Texas Health Science Center, United States of AmericaDavid Karol - Department of Psychiatry and Behavioral Neuroscience, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of AmericaShannon Suo - Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, CA, United States of AmericaMichael Lang - Departments of Psychiatry and Internal Medicine, East Carolina University, Greenville, NC, United States of AmericaMarsha Stern - Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of AmericaE Vanessa Spearman - Departments of Internal Medicine and Psychiatry, Medical College of Georgia at Augusta University Medical Center, Augusta, GA, United States of AmericaJohn Onate - Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, CA, United States of AmericaAniyizhai Annamalai - Departments of Psychiatry and Internal Medicine, Yale School of Medicine, New Haven, CT, United States of AmericaZeina Saliba - Department of Psychiatry & Behavioral Sciences and Department of Emergency Medicine, The George Washington University, Washington, D.C, Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, United States of AmericaThomas Heinrich - Departments of Psychiatry and Behavioral Medicine, Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of AmericaJess G Fiedorowicz - Departments of Psychiatry, Epidemiology, and Internal Medicine, University of Iowa, Iowa City, IA, United States of America
- Resource Type
- Journal article
- Publication Details
- Journal of psychosomatic research, Vol.135, pp.110138-110138
- Publisher
- England
- DOI
- 10.1016/j.jpsychores.2020.110138
- PMID
- 32442893
- ISSN
- 0022-3999
- eISSN
- 1879-1360
- Language
- English
- Date published
- 08/2020
- Academic Unit
- Psychiatry; Epidemiology; Iowa Neuroscience Institute
- Record Identifier
- 9984070437202771
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