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. 2021 Nov 19:17:3395-3405.
doi: 10.2147/NDT.S334350. eCollection 2021.

Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Monica Zolezzi  1 , Athar Elhakim  2 , Waad M Elamin  1 , Shorouk Homs  1 , Doaa E Mahmoud  1 , Iman A Qubaiah  1
Affiliations

Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Monica Zolezzi et al. Neuropsychiatr Dis Treat. .

Abstract

Background: QTc interval (QTcI) prolongation leads to serious complications, making it a concern for clinicians. Assessing the risk of QTcI prolongation in the psychiatric population is important because they are exposed to multiple medications known to increase the risk of life-threatening arrhythmias.

Aim: The study aims to validate the content of an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population.

Methodology: Qualitative semi-structured interviews of cardiologists, to gather information regarding their approach in assessing the risk of drug-induced QTc prolongation at the time of prescribing. After the interview, an orientation to the algorithm was provided with a link to a cross-sectional, anonymous survey. The online survey included quantitative and qualitative components to gather feedback on the relevance and appropriateness of each step in the algorithm.

Results: Interview responses were incorporated into 4 themes. Responses indicated a lack of a unified protocol when assessing QTcI prolongation, which supports the need of an algorithm that includes a verified risk scoring tool. Quantitative survey results showed a mean score ranging from 3.08 to 3.67 out of 4 for the appropriateness of the algorithm's steps, 3.08 to 3.58 for the safety and 3.17 to 3.75 for the reliability of references used. Additional analysis using the modified kappa and I-CVI statistical measures indicate high validity of contents and high degree of agreement between raters. As per the open-ended questions, cardiologists supported the implementation of the algorithm; however, they recommended simplification of the steps as they appear to be cumbersome.

Conclusion: The results demonstrate that the implementation of the algorithm after minor alterations can prove to be useful as a tool for the risk assessment of QTc prolongation. Further validation of the algorithm with mental health pharmacists and clinicians will be conducted as a separate phase of the study.

Keywords: QTc prolongation; algorithm; drug-induced arrhythmias; psychiatric population.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic representation of the study design.
Figure 2
Figure 2
Reliability CVI scores of the QTcI Prolongation Algorithm. (A) presents the mean score of the appropriateness rating for each step of the algorithm in addition to the I-CVI. (B) presents the mean score for the safety of each step of the algorithm in addition to the I-CVI. (C) presents the mean score of the reliability of the references used in each step of the algorithm in addition to the I-CVI.
Figure 3
Figure 3
Word-cloud representation of survey open-ended responses.
None
See this image and copyright information in PMC

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