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Assistant Professor of Clinical Pharmacy, Department of Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, CA
at time of the study, Pharmacy Practice Resident, School of Pharmacy, University of Southern California; now, Pharmacist, University of Michigan Health System, Ann Arbor, MI
at time of the study, Pharmacy Practice Resident, School of Pharmacy, University of Southern California; now, Pharmacist, New York Harbor Healthcare, NY
at time of the study, Pharmacy Practice Resident, School of Pharmacy, University of Southern California; now, Emergency Department Clinical Pharmacist, Huntington Memorial Hospital, Pasadena, CA
Assistant Professor of Pharmacoeconomics, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
PharmD Student, School of Pharmacy, University of Southern California
PharmD Student, School of Pharmacy, University of Southern California
Statistician, Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE
Reprints: Dr. Ng, Department of Pharmacy, School of Pharmacy, University of Southern California, 1985 Zonal Ave., Los Angeles, CA 90033, fax 323/442-1681, tienng{at}usc.edu
BACKGROUND: No data exist regarding the value of pharmacist monitoring of drugs associated with QTc interval prolongation.
OBJECTIVE: To assess the capability, clinical impact, and economic impact of pharmacists monitoring for drug-induced QTc interval prolongation in critically ill medical adult patients.
METHODS: In a prospective, parallel-group study, 149 consecutive
medical intensive care unit (ICU) patients prescribed a QTc
interval-prolonging drug at the Los Angeles County + University of Southern
California Medical Center were assigned on alternating days to an intervention
group (clinical pharmacist on physician team monitored drugs using a
standardized algorithm) or a standard care group (team without pharmacist
using an algorithm). The monitoring algorithm used daily assessments of
electrocardiograms and laboratory data to generate pharmacotherapeutic
recommendations. The primary endpoint was the frequency of QTc interval
prolongation (>500 msec at any time or an increase 
60 msec over
baseline). Secondary endpoints included QTc interval greater than 470 msec in
women or greater than 450 msec in men, mean increase in QTc interval at 48
hours, recommendation acceptance rate, and cost of care.
RESULTS: QTc interval prolongation occurred less frequently in the intervention group compared with the standard care group (19% vs 39%, respectively; p = 0.006). Incidence of QTc interval greater than 500 msec (13% vs 33%, respectively; p = 0.003) was also lower in the intervention group. Incidence of QTc interval increase of 60 msec or more over baseline (12% vs 21%, respectively; p = 0.12) and increase in QTc interval at 48 hours over baseline (mean ± SD; 6.4 ± 40.8 vs 18.2 ± 42.3 msec, respectively; p = 0.097) were not significantly different between the groups. Algorithm-generated recommendations were accepted 70% of the time by the intervention group physician team. Total cost and cost per day were not significantly different between groups.
CONCLUSIONS: In this preliminary study, pharmacist monitoring of QTc interval-prolonging drugs using a simple algorithm was feasible and reduced the risk of QTc interval prolongation. Further studies that monitor other proarrhythmic medications are warranted.
Key Words: critical care, pharmacist intervention, QTc interval prolongation, torsade de pointes
Published Online, March 4, 2008. www.theannals.com, DOI 10.1345/aph.1K458
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