QT interval and antidepressant use: a cross sectional study of electronic health records.
QT interval and antidepressant use: a cross sectional study of electronic health records.
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DOI：
10.1136/bmj.f288
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发表时间：
2013-01-29
期刊：
影响因子：
--
通讯作者：
Perlis RH
中科院分区：
文献类型：
--
作者：
Castro VM;Clements CC;Murphy SN;Gainer VS;Fava M;Weilburg JB;Erb JL;Churchill SE;Kohane IS;Iosifescu DV;Smoller JW;Perlis RH
目的探讨西酞普兰和其他选择性5-羟色胺再摄取抑制剂对临床人群中室性心律失常危险指标校正QT间期(QTC)的影响。设计一项横断面研究，使用来自电子健康记录的心电图、处方和临床数据来探索抗抑郁药物剂量与QTC之间的关系。美沙酮，一种已知可以延长QT的阿片类药物，被纳入以证明测定的敏感性。建立一个由两个学术医疗中心和门诊诊所组成的大型新英格兰医疗保健系统。研究对象1990年2月至2011年8月期间，38例 397例成人患者在服用抗抑郁药或美沙酮后记录到心电图。主要观察指标线性回归中抗抑郁药剂量与QTC间期的关系，调整潜在的临床和人口学混杂变量。对于一组患者，也检查了服药后QTC的变化。结果与QTcs延长相关的剂量-反应关系包括西酞普兰(调整后的Beta0.10(SE0.04)，P<；0.01)、艾司匹兰(调整后的Beta0.58(0.15)，P<；0.001)和阿米替林(调整后的Beta0.11(0.03)，P<；0.001)，而其他被研究的抗抑郁药没有。安非他酮(调整后的β0.02(0.01)P<；0.05)与QTcs缩短有关。受试者内配对观察支持西酞普兰的QT间期延长效应(10 mg至20 mg，QT_c平均增加7.8(SE 3.6)ms，调整后P&t；0.05；20 mg至40 mg，QT_c平均增加10.3(4.0)ms，调整P<；0.01)。结论本研究证实了西酞普兰可适度延长QT间期，并确定了具有相似观察风险的其他抗抑郁药物。使用电子健康记录数据的药物警戒研究可能是识别与治疗相关的潜在风险的有用方法。
Objective To quantify the impact of citalopram and other selective serotonin reuptake inhibitors on corrected QT interval (QTc), a marker of risk for ventricular arrhythmia, in a large and diverse clinical population. Design A cross sectional study using electrocardiographic, prescribing, and clinical data from electronic health records to explore the relation between antidepressant dose and QTc. Methadone, an opioid known to prolong QT, was included to demonstrate assay sensitivity. Setting A large New England healthcare system comprising two academic medical centres and outpatient clinics. Participants 38 397 adult patients with an electrocardiogram recorded after prescription of antidepressant or methadone between February 1990 and August 2011. Main outcome measures Relation between antidepressant dose and QTc interval in linear regression, adjusting for potential clinical and demographic confounding variables. For a subset of patients, change in QTc after drug dose was also examined. Results Dose-response association with QTc prolongation was identified for citalopram (adjusted beta 0.10 (SE 0.04), P<0.01), escitalopram (adjusted beta 0.58 (0.15), P<0.001), and amitriptyline (adjusted beta 0.11 (0.03), P<0.001), but not for other antidepressants examined. An association with QTc shortening was identified for bupropion (adjusted beta 0.02 (0.01) P<0.05). Within-subject paired observations supported the QTc prolonging effect of citalopram (10 mg to 20 mg, mean QTc increase 7.8 (SE 3.6) ms, adjusted P<0.05; and 20 mg to 40 mg, mean QTc increase 10.3 (4.0) ms, adjusted P<0.01). Conclusions This study confirmed a modest prolongation of QT interval with citalopram, and identified additional antidepressants with similar observed risk. Pharmacovigilance studies using electronic health record data may be a useful method of identifying potential risk associated with treatments.
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影响因子：
2.9
作者：
Castro VM;Gallagher PJ;Clements CC;Murphy SN;Gainer VS;Fava M;Weilburg JB;Churchill SE;Kohane IS;Iosifescu DV;Smoller JW;Perlis RH
通讯作者：
Perlis RH
影响因子：
2.6
作者：
Enger, C;Cali, C;Walker, AM
通讯作者：
Walker, AM
影响因子：
2.8
作者：
Jeon, Seol-Hee;Jaekal, Jun;Kim, Eun-Jung
通讯作者：
Kim, Eun-Jung
影响因子：
3.4
作者：
van Noord, Charlotte;Eijgelsheim, Mark;Stricker, Bruno H. Ch.
通讯作者：
Stricker, Bruno H. Ch.
DOI：
10.1136/jamia.2009.000893
发表时间：
2010-03-01
影响因子：
6.4
作者：
Murphy, Shawn N.;Weber, Griffin;Kohane, Isaac
通讯作者：
Kohane, Isaac