Vandael et al reported a score for identifying a hospitalized psychiatric patient at risk for torsades de pointes. This can be used on other patient populations as well. The authors are from University of Leuven and Public Health and Surveillance Brussels.
Patient selection: psychiatric patient
Parameters:
(1) age of the patient in years
(2) sex of the patient
(3) current smoking
(4) body mass index in kg per square meter
(5) ischemic cardiomyopathy
(6) hypertension
(7) arrhythmia
(8) QTc on baseline ECG
(9) thyroid disturbance
(10) diabetes mellitus
(11) serum potassium concentration in mmol/L
(12) serum creatinine in mg/dL
(13) number of drugs on list of drugs known to prolong QTc (listed on CredibleMeds.com)
(14) number of drugs on list of drugs with possible risk of prolonging QTc (listed on CredibleMeds.com)
(15) number of drugs with conditional risk of Torsades de Pointes (listed on CredibleMeds.com)
|
Parameter |
Finding |
Points |
|
age |
< 65 years |
0 |
|
|
>= 65 years |
3 |
|
sex |
female |
3 |
|
|
male |
0 |
|
smoking |
no |
0 |
|
|
yes |
3 |
|
BMI |
> 30 kg per sq m |
0 |
|
|
>= 30 kg per sq m |
1 |
|
ischemic cardiomyopathy |
no |
0 |
|
|
yes |
3 |
|
arrhythmia |
no |
0 |
|
|
yes |
3 |
|
QTc baseline ECG |
male and < 450 ms |
0 |
|
|
male and >= 450 ms |
6 |
|
|
female and < 470 ms |
0 |
|
|
female and >= 470 ms |
6 |
|
thyroid disturbance |
no |
0 |
|
|
yes |
3 |
|
diabetes |
no |
0 |
|
|
yes |
0.5 |
|
serum potassium |
<= 3.5 mmol/L |
6 |
|
|
> 3.5 mmol/L |
0 |
|
serum creatinine |
male and <= 1.15 mg/dL |
0 |
|
|
male and > 1.15 mg/dL |
0.5 |
|
|
female and <= 0.95 mg/dL |
0 |
|
|
female and > 0.95 mg/dL |
0.5 |
|
drugs known to prolong |
|
3 * |
|
drugs possible risk |
|
0.5 * |
|
drugs with conditional risk |
|
0.25 * |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 35 +
• A score >= 8 was associated with a high risk of a significantly longer QTc interval.
Specialty: Cardiology
