Dr. Monica Zolezzi
Doha, Qatar: Qatar University’s (QU) College of Pharmacy takes a significant leap forward in patient safety with its groundbreaking initiative to develop a web-based Electronic Clinical Decision Support (ECDS) application.
This revolutionary tool aims to assess and manage the risk of drug-induced prolongation of the heart’s QTc interval (QTcI), a concern that has worried clinicians at the time of prescribing. The project, led by Dr. Monica Zolezzi, Associate Professor and Acting Director of the Doctor of Pharmacy Programme, in collaboration with the Epidemiology Coordinating and Research Centre (EPICORE) at the University of Alberta, Canada, holds the promise of making prescribing decisions safer and more effective for healthcare professionals.
The challenge faced by clinicians lies in identifying the specific risk factors for TdP or medications that can lead to QTcI prolongation. The vast array of available medications and non-drug factors involved in risk assessment can make it difficult for clinicians to determine the potential safety risks before initiating a new treatment for patients. However, a ray of hope shines through the crucial role of pharmacists in monitoring drug-drug interactions (DDIs) during the prescription process.
For years, healthcare professionals have been grappling with the risk of QTc interval prolongation, as it can lead to a life-threatening condition called torsades de pointes (TdP) and sudden cardiac death (SCD). This risk is especially concerning for patients with serious mental illnesses (SMI), who already face increased vulnerability to premature mortality. Medications used to treat SMI have been associated with an elevated risk of SCD in this population. Additionally, other commonly used medications like antiarrhythmic medications, antibiotics, antifungals, and antiemetics have also been linked to QTcI prolongation and TdP.
In response to these challenges, Dr. Zolezzi and her team at QU have developed an evidence-based algorithm, incorporating a comprehensive review of the latest guidelines for the assessment, monitoring, and management of drug-induced QTcI prolongation. This algorithm presents a series of clinical questions designed to aid in the rationalization of decision-making processes when prescribing medications known to increase QTcI. Moreover, it emphasizes the need for consultation with cardiology experts at critical stages of the decision-making process, particularly when assessing individuals at risk of QTcI prolongation or interpreting electrocardiograms (ECGs).
Community pharmacies, like those found in outpatient settings, play a pivotal role in the healthcare landscape. Pharmacists are often consulted about medications that could prolong QTcI, and their advice extends beyond simply informing patients about potential risks. They may also need to delve into patient characteristics and treatment regimens to effectively provide relevant guidance. To facilitate this process, an intervention study in the Netherlands employed an ECDS tool, which proved effective in managing potential QTcI-prolonging DDIs and ensuring the safe and effective use of psychotropic drugs in the mental health population.
With the support of a high-impact grant, QU is now working to transform the QTcI algorithm into a web-based ECDS application, facilitating better prescribing decisions in both acute and non-acute settings. Collaborating with the Epidemiology Coordinating and Research Centre (EPICORE) at the University of Alberta, Canada, QU aims to enhance the usability and utility of the algorithm.
This effort aligns with a Qatar-based project involving the Arabic translation, cultural adaptation, and incorporation of a web and mobile application for assessing, monitoring, and managing cardiovascular risk, which is currently being investigated for feasibility in primary care centers in Qatar. By incorporating the QTcI algorithm into ECDS and health management systems, clinicians will have an invaluable tool at their disposal for identifying patients at risk of QTcI prolongation.
This critical step will significantly enhance the decision-making process during medication prescription, thereby safeguarding patients from potential medication-induced arrhythmias and ultimately saving lives.
