A Real-World Study of Risk Factors for QTc Prolongation in Schizophrenia Patients Receiving Atypical Antipsychotics

Background: The risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) can be classified in commonly-used stroke risk stratification scores. The role of the pattern of atrial fibrillation in risk prediction is unclear in contemporary ‘real world’ cohorts. Methods: Patients diagnosed with NVAF in a four-hospital-institution between 2000 and 2010 were identified and included. Event rates of stroke/TE were calculated according to pattern of AF, i.e. paroxysmal, persistent and permanent, defined by consensus guidelines. Independent risk factors of stroke/TE were investigated by Cox regression. Results: Among 7156 patients with NVAF, 4176 (58.4%) patients with paroxysmal, 376 (5.3%) with persistent and 2604 (36.3%) with permanent NVAF patterns were included. In non-anticoagulated patients, the overall stroke/TE event rate per 100 person-years was 1.29 (95% CI 1.13–1.47). Paroxysmal NVAF patients were more likely to be female (p<0.001). Persistent NVAF patients were less likely to have prior history of stroke (p–0.002) and vascular disease (p<0.001), and more likely to have hypertension (p<0.001) and vitamin K antagonist therapy (p<0.001). Permanent NVAF patients were more likely to have diabetes (p<0.001), heart failure therapy (p<0.001) and less likely to have dyslipidaemia (p<0.001). Compared with paroxysmal NVAF, rates of stroke/TE (p=0.001), bleeding (p<0.001) and all-cause mortality (p<0.001) were significantly higher in permanent NVAF patients but not in persistent NVAF patients. In multivariate analyses, only previous stroke (hazard ratio, HR 2.58, 95% CI 2.08–3.21), vascular disease (HR 1.34,1.12–1.61), heart failure (HR 1.20,1.00–1.44), age≥75 years (HR 2.75, 2.16–3.50) and age 65–74 years (HR 1.60,1.22–2.09) increased stroke/TE risk, but persistent (HR1.13, 0.76–1.70) and permanent (HR 1.44,0.96–2.16) patterns of NVAF did not. Conclusion: In this large ‘real world’ cohort of NVAF patients, there were significant differences in rates of stroke, TE, death and bleeding between patterns of NVAF, however only previous stroke, age, heart failure and vascular disease (not pattern of NVAF) independently increased the risk of stroke/TE, death and bleeding in multivariate analyses. Therefore, the risk of stroke is similar across all patterns of NVAF and antithrombotic therapy should be based on clinical risk factors not NVAF pattern.

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Risk of QTc Interval Prolongation Associated With Circulating Anti‐Ro/SSA Antibodies Among US Veterans: An Observational Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018735 ◽

2021 ◽

Vol 10 (4) ◽

Author(s):

Pietro Enea Lazzerini ◽

Gabriele Cevenini ◽

Yongxia Sarah Qu ◽

Frank Fabris ◽

Nabil El‐Sherif ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Small Sample ◽

Observational Cohort Study ◽

Current Evidence ◽

Qtc Interval ◽

Qtc Prolongation ◽

Increased Risk ◽

Observational Cohort ◽

Us Veterans

Background Anti‐Sjögren's syndrome‐related antigen A‐antibodies (anti‐Ro/SSA‐antibodies) are responsible for a novel form of acquired long‐QT syndrome, owing to autoimmune‐mediated inhibition of cardiac human ether‐a‐go‐go‐related gene‐potassium channels. However, current evidence derives only from basic mechanistic studies and relatively small sample‐size clinical investigations. Hence, the aim of our study is to estimate the risk of QTc prolongation associated with the presence of anti‐Ro/SSA‐antibodies in a large population of unselected subjects. Methods and Results This is a retrospective observational cohort study using the Veterans Affairs Informatics and Computing Infrastructure. Participants were veterans who were tested for anti‐Ro/SSA status and had an ECG. Descriptive statistics and univariate and multivariate logistic regression analyses were performed to identify risk factors for heart rate‐corrected QT interval (QTc) prolongation. The study population consisted of 7339 subjects (61.4±12.2 years), 612 of whom were anti‐Ro/SSA‐positive (8.3%). Subjects who were anti‐Ro/SSA‐positive showed an increased prevalence of QTc prolongation, in the presence of other concomitant risk factors (crude odds ratios [OR], 1.67 [1.26–2.21] for QTc >470/480 ms; 2.32 [1.54–3.49] for QTc >490 ms; 2.77 [1.66–4.60] for QTc >500 ms), independent of a connective tissue disease history. Adjustments for age, sex, electrolytes, cardiovascular risk factors/diseases, and medications gradually attenuated QTc prolongation estimates, particularly when QT‐prolonging drugs were added to the model. Nevertheless, stepwise‐fully adjusted OR for the higher cutoffs remained significantly increased in anti‐Ro/SSA‐positive subjects, particularly for QTc >500 ms (2.27 [1.34–3.87]). Conclusions Anti‐Ro/SSA‐antibody positivity was independently associated with an increased risk of marked QTc prolongation in a large cohort of US veterans. Our data suggest that within the general population individuals who are anti‐Ro/SSA‐positive may represent a subgroup of patients particularly predisposed to ventricular arrhythmias/sudden cardiac death.

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Real-world incidence and risk factors for daytime and nocturnal non-severe hypoglycemia in adults with type 2 diabetes mellitus on insulin and/or secretagogues (InHypo-DM Study, Canada)

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2021.09.004 ◽

2021 ◽

Author(s):

Natalie H. Au ◽

Alexandria Ratzki-Leewing ◽

Guangyong Zou ◽

Bridget L. Ryan ◽

Susan Webster-Bogaert ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Real World ◽

Severe Hypoglycemia

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P-167: Real-world elderly myeloma patients: improved survival despite more adverse risk factors than younger patients and RCT populations. A study on behalf of the Nordic Myeloma Study Group

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/s2152-2650(21)02294-1 ◽

2021 ◽

Vol 21 ◽

pp. S127-S128

Author(s):

Kari Lenita Falck Moore ◽

Cecilie Hveding Blimark ◽

Annette Juul Vangsted ◽

Ingemar Turesson ◽

Tobias Klausen ◽

...

Keyword(s):

Risk Factors ◽

Real World ◽

Study Group ◽

Younger Patients

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Prevalence of risk factors for QT prolongation and torsades de pointes among women with HR+/HER2– advanced or metastatic breast cancer treated in real-world settings in Italy and Germany

Annals of Oncology ◽

10.1093/annonc/mdz100.016 ◽

2019 ◽

Vol 30 ◽

pp. iii53

Author(s):

N. Harbeck ◽

E.H. Law ◽

M. Ajmera ◽

D. Mitra ◽

K. Davis ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Metastatic Breast Cancer ◽

Real World ◽

Metastatic Breast ◽

Torsades De Pointes ◽

Qt Prolongation

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Prevalence and risk factors of prolonged corrected QT interval in general Chinese population

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1244-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Qun Ma ◽

Zhao Li ◽

Xiaofan Guo ◽

Liang Guo ◽

Shasha Yu ◽

...

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Chinese Population ◽

Liaoning Province ◽

Qtc Interval ◽

Qtc Prolongation ◽

Cvd Risk ◽

Specific Risk ◽

Increased Risk ◽

General Chinese Population

Abstract Background Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community. Methods A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders. Results The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval. Conclusions The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.

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