Use of Electrocardiogram Monitoring in Adult Patients Taking High-Risk QT Interval Prolonging Medicines in Clinical Practice: Systematic Review and Meta-analysis

Abstract

Introduction: Electrocardiogram (ECG) monitoring is an important tool to detect and mitigate the risk of potentially fatal drug-induced QT prolongation and remains fundamental in supporting the quality use of high-risk QT interval prolonging medicines.

Objective: The aim of this systematic review was to determine the prevalence of baseline and/or follow-up ECG use in adult patients taking high-risk QT interval prolonging medicines in clinical practice.

Methods: CINAHL, Cochrane Library, Embase, PubMed, EThOS, OpenGrey and Proquest were searched for studies in adults that reported ECG use at baseline and/or at follow-up in relation to the initiation of a high-risk QT interval prolonging medicine in any clinical setting; either hospital or non-hospital. Two reviewers independently assessed the methodological quality of included studies. Proportional meta-analysis was conducted with all studies reporting baseline ECG use, before medicine initiation, and follow-up ECG use, within 30 days of medicine initiation.

Results: There was variability in baseline ECG use according to the practice setting. The prevalence of baseline ECG use for high-risk QT interval prolonging medicines was moderate to high in the hospital setting at 75.1% (95% CI 64.3-84.5); however, the prevalence of baseline ECG use was low in the non-hospital setting at 33.7% (95% CI 25.8-42.2). The prevalence of follow-up ECG use was low to moderate in the hospital setting at 39.2% (95% CI 28.2-50.8) and could not be determined for the non-hospital setting.

Conclusions: The use of ECG monitoring for high-risk QT interval prolonging medicines is strongly influenced by the clinical practice setting. Baseline ECG use occurs more in the hospital setting in comparison to the non-hospital setting. There is lower use of follow-up ECG in comparison to baseline ECG.

Fig. 1

Flow diagram of search results and review process (PRISMA 2020) [13]

Fig. 2

Proportional meta-analysis of baseline ECG use—hospital setting only and leave three out (studies with additional biases)

Fig. 3

Proportional meta-analysis of baseline ECG use—non-hospital setting only

Fig. 4

Proportional meta-analysis of follow-up ECG use—hospital setting only and leave two out (studies with additional biases)

Fig. 5

Proportional meta-analysis of follow-up ECG use—hospital setting only and high-quality studies only; any clinical setting and high-quality studies only

Fig. 6

Proportional meta-analysis of follow-up ECG use—any clinical setting and leave two out (studies with additional biases)