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Prevalence of QTc prolongation in patients with advanced cancer receiving palliative care – a cause for concern?
Janet R. Hardy, BSc, FRACP, MD (Prof)1,∗,'Correspondence information about the author BSc, FRACP, MD Janet R. HardyEmail the author BSc, FRACP, MD Janet R. Hardy, Dr Daniel Bundock2, Dr Jessica Cross2, Kristen Gibbons, Senior Epidemiologist (A/Prof)3, Ross Pinkerton (Prof)4, Dr Korana Kindl5, Phillip Good (A/Prof)5, Jennifer Philip (Prof)6
PlumX Metrics
DOI: https://doi.org/10.1016/j.jpainsymman.2019.12.356
Abstract
Context
Medications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval on a standard ECG.
Objectives
To document the prevalence of a prolonged QTc interval in the palliative/oncology setting, compare automatic ECG QTc measurements with manual readings and identify any correlation between QTc prolongation and the use of drugs or other risk factors.
Methods
A convenience sample of consecutive patients with cancer, admitted under or known to the palliative/supportive care teams in two metropolitan hospitals and willing to provide an ECG recording and basic demographic information including QTc risk factors were included. Both automated and manually calculated QTc intervals were recorded. Multivariable analysis was used to determine risk factors independently associated with prolonged QTc intervals.
Results
Of the 389 participants, there was a significant difference in mean QTc between sites using automated but not manual calculations. Manual readings were therefore used with predetermined cut-offs of 0.44sec (males) and 0.46sec (females). 72 (18.5%) of participants had a prolonged QTc with 6 (1.5%) having a prolongation >0.50sec. “At-risk” drugs were being taken by 218 participants (56.0% of total cohort). Factors shown to be associated with QTc prolongation included age, gender, performance status and hypocalcaemia. No specific medication was associated with increased risk.
Conclusion
Although almost 20% of patients receiving palliative care had prolongation of QTc, the risk of serious consequences appeared to be low despite the frequent occurrence of risk factors.
Key words:
electrocardiogram, QTc prolongation, palliative care
Prevalence of QTc prolongation in patients with advanced cancer receiving palliative care – a cause for concern?
Janet R. Hardy, BSc, FRACP, MD (Prof)1,∗,'Correspondence information about the author BSc, FRACP, MD Janet R. HardyEmail the author BSc, FRACP, MD Janet R. Hardy, Dr Daniel Bundock2, Dr Jessica Cross2, Kristen Gibbons, Senior Epidemiologist (A/Prof)3, Ross Pinkerton (Prof)4, Dr Korana Kindl5, Phillip Good (A/Prof)5, Jennifer Philip (Prof)6
PlumX Metrics
DOI: https://doi.org/10.1016/j.jpainsymman.2019.12.356
Abstract
Context
Medications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval on a standard ECG.
Objectives
To document the prevalence of a prolonged QTc interval in the palliative/oncology setting, compare automatic ECG QTc measurements with manual readings and identify any correlation between QTc prolongation and the use of drugs or other risk factors.
Methods
A convenience sample of consecutive patients with cancer, admitted under or known to the palliative/supportive care teams in two metropolitan hospitals and willing to provide an ECG recording and basic demographic information including QTc risk factors were included. Both automated and manually calculated QTc intervals were recorded. Multivariable analysis was used to determine risk factors independently associated with prolonged QTc intervals.
Results
Of the 389 participants, there was a significant difference in mean QTc between sites using automated but not manual calculations. Manual readings were therefore used with predetermined cut-offs of 0.44sec (males) and 0.46sec (females). 72 (18.5%) of participants had a prolonged QTc with 6 (1.5%) having a prolongation >0.50sec. “At-risk” drugs were being taken by 218 participants (56.0% of total cohort). Factors shown to be associated with QTc prolongation included age, gender, performance status and hypocalcaemia. No specific medication was associated with increased risk.
Conclusion
Although almost 20% of patients receiving palliative care had prolongation of QTc, the risk of serious consequences appeared to be low despite the frequent occurrence of risk factors.
Key words:
electrocardiogram, QTc prolongation, palliative care
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