Clinicians’ adherence to clinical practice guidelines for cardiac function monitoring during antipsychotic treatment: a retrospective report on 434 patients with severe mental illness

BMC Psychiatry

Research Article

Federica Pinna¹  Giorgio Firinu¹  Bernardo Carpiniello¹  Mirko Manchia² 

[1] Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Via Liguria 13, 09127, Cagliari, Italy;Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Via Liguria 13, 09127, Cagliari, Italy;Department of Pharmacology, Dalhousie University, Halifax, NS, Canada;

关键词: Torsade de point;    Electrolytes;    ECG;    Excess mortality;    Side effects;   

DOI  :  10.1186/s12888-017-1289-z

 received in 2016-08-27, accepted in 2017-03-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSevere mental illness (SMI) has considerable excess morbidity and mortality, a proportion of which is explained by cardiovascular diseases, caused in part by antipsychotic (AP) induced QT-related arrhythmias and sudden death by Torsade de Point (TdP). The implementation of evidence-based recommendations for cardiac function monitoring might reduce the incidence of these AP-related adverse events. To investigate clinicians’ adherence to cardiac function monitoring before and after starting AP, we performed a retrospective assessment of 434 AP-treated SMI patients longitudinally followed-up for 5 years at an academic community mental health center.MethodsWe classified antipsychotics according to their risk of inducing QT-related arrhythmias and TdP (Center for Research on Therapeutics, University of Arizona). We used univariate tests and multinomial or binary logistic regression model for data analysis.ResultsUnivariate and multinomial regression analysis showed that psychiatrists were more likely to perform pre-treatment electrocardiogram (ECG) and electrolyte testing with AP carrying higher cardiovascular risk, but not on the basis of AP pharmacological class. Univariate and binomial regression analysis showed that cardiac function parameters (ECG and electrolyte balance) were more frequently monitored during treatment with second generation AP than with first generation AP.ConclusionsOur data show the presence of weaknesses in the cardiac function monitoring of AP-treated SMI patients, and might guide future interventions to tackle them.

【 授权许可】

CC BY   
© The Author(s). 2017