Mario Bo1, Alice Ceccofiglio2, Chiara Mussi3, Giuseppe Bellelli4, Franco Nicosia5, Daniela Riccio6, Anna M Martone7, Assunta Langellotto8, Elisabetta Tonon9, Gianni Tava10, Virginia Boccardi11, Pasquale Abete12, Michela Tibaldi1, Maria L Aurucci13, Gianfranco Fonte1, Yolanda Falcone1, Andrea Ungar2. 1. Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy. 2. Syncope Unit, Department of Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy. 3. O.U. of Geriatrics, Department of Biomedical Sciences, Metabolics and Neurosciences, University of Modena and Reggio Emilia, Italy. 4. Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy. 5. Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy. 6. Geriatric Department, SS, Trinità Hospital, Cagliari, Italy. 7. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy. 8. S. Maria di Ca' Foncello Hospital, Treviso, Italy. 9. S. Jacopo Hospital, Azienda USL 3, Pistoia, Italy. 10. Geriatric Unit, Santa Chiara Hospital, Trento, Italy. 11. Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy. 12. Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy. 13. Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy. Electronic address: marialuigia.aurucci@unito.it.
Abstract
BACKGROUND: Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. METHODS: Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12‑lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. RESULTS: Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with one-year mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. CONCLUSIONS: We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF.
BACKGROUND: Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. METHODS: Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12‑lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. RESULTS: Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with one-year mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. CONCLUSIONS: We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF.