Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium.
BACKGROUND
Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death.


OBJECTIVE
To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk.


SETTING
University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered.


MAIN OUTCOME MEASURE
Management of the risk of QTc-prolongation.


RESULTS
Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020).


CONCLUSIONS
Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.
['Vandael|Eline|E|', 'Vandenberk|Bert|B|', 'Vandenberghe|Joris|J|', 'Spriet|Isabel|I|', 'Willems|Rik|R|', 'Foulon|Veerle|V|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D014150:Antipsychotic Agents D001530:Belgium D004562:Electrocardiography D005500:Follow-Up Studies D006220:Haloperidol D006785:Hospitals, University D006801:Humans D008133:Long QT Syndrome D008875:Middle Aged D012308:Risk Management D016171:Torsades de Pointes D055815:Young Adult
Risk management QTc-prolongation Haloperidol Torsade de Pointes Sudden cardiac death