Prevalence of Medication Associated with QTc Prolongation Used Among Critically Ill Patients.

Background: Acquired prolonged corrected QT (QTc) interval can lead to life-threatening Torsade de Pointes (TdP) arrhythmia. Multiple risk factors including medications, comorbidities, and electrolyte imbalances contribute significantly to acquired manifestations of the QTc prolongation. Critically ill patients are particularly more vulnerable to TdP due to complex medical conditions, aging, and polypharmacy. Objective: This study aimed to assess the prevalence of TdP-associated medication prescribing, identify risk factors for QTc prolongation and TdP, and determine primary predictors of high TdP medication usage in critically ill patients in Jordan. Methods: We conducted a retrospective cross-sectional analysis of electronic medical records for patients from King Abdullah University Hospital who were admitted to Intensive Care Unit (ICU) between (July 2012-July 2022). We collected data on patients' demographics, clinical characteristics, comorbidities, laboratory results, and prescribed medications. Medications were categorized into three TdP risk levels according to CredibleMeds® assessment tool. Data were analyzed using descriptive statistics and a binary logistic regression model. Results: Of the 13,300 patients (58.2% male, median age 62 years). Prescribing prevalence for medications with known TdP risk was 19%, possible risk (24.7%), conditional risk (21.6%), and confirmed conditional risk (8.3%). Common comorbidities included hypertension (40.9%), diabetes (33.3%), and cancer (15.4%). Drugs with known TdP risk included citalopram, amiodarone, clarithromycin, and ciprofloxacin. A binary regression model revealed that as age increased, the odds of TdP associated medication prescribing decreased (OR = 0.989, p < 0.001), while patients on more than five medications had higher odds (OR = 4.281, p < 0.001). Conclusion: The study identified a notable prevalence of prescribing for medications with QTc prolongation/TdP risk in critically ill patients. Healthcare providers in the ICU should exercise caution to minimize the inadvertent prescription of TdP associated medications especially among older patients and those with polypharmacy.

Medication Adherence and Its Associated Determinants in Older Adults with Type 2 Diabetes and Cardiovascular Comorbidities.

Aims of the Study: To evaluate medication adherence level and identify predictors of poor medication adherence in elderly patients with Cardiovascular (CVS) diseases and type 2 diabetes in Jordan. Methods: This cross-sectional study was conducted on elderly patients who attended King Abdullah University Hospital (KAUH) outpatient diabetes and cardiology clinics from March 6, 2023, to July 6, 2023. Data on age, sex, socio-demographics, biological variables, medication characteristics, and chronic comorbidities were obtained from electronic patients' medical records and a validated questionnaire. Medication adherence levels (low, moderate, and high) were assessed using the Arabic version of the 4-item Morisky, Green, and Levine Medication Adherence Scale-Medication Assessment Questionnaire. Results: Data from 506 elderly patients were analyzed. The average age of the participants was 67.93 years (SD = 6.22). 7.9% of patients showed low adherence levels, 33.6% showed moderate adherence level, and 58.5% of patients showed a high level of adherence toward their prescribed medications. Multivariable ordinal logistic regression analysis revealed that single/currently unmarried patients and patients who were living with others were more likely to have a higher adherence level; Odd Ratios (ORs) were 4.75 and 4.10, respectively. Patients who took their medications ≥ 3 and 2 times a day showed higher adherence to their medications than those who only took them once a day.; ORs were 2.15 and 2.36, respectively. Conclusion: This study indicated an inadequate level of adherence among patients with type 2 diabetes and cardiovascular comorbidities. This study revealed the necessity of implementing programs to help in raising the awareness among elderly patients with type 2 diabetes and CVDs of the importance of adherence to prescribed long-term medication regimens.

Assessment of Drug-Related Problems and Health-Related Quality of Life Domains in Elderly Patients with Type 2 Diabetes Mellitus.

Aims of the Study: This study aimed to investigate the prevalence and predictors of Drug-related problems (DRPs), as well as to evaluate the impact of DRPs on the health-related quality of life in geriatric patients with type 2 diabetes mellitus. Methodology: A cross-sectional study was conducted over a three-month period. Patients aged 60 years and older visited diabetes clinics from October 1, 2022, to December 31, 2022, were included in the study. Data were collected through structured questionnaires, whereas lab results, medication records, comorbidities, and the consequences of DRPs were collected from electronic medical records. DRPs were identified and classified using the PCNE V501 classification system. Health-related quality of life (HRQoL) was evaluated using the validated EuroQol criteria. Results: A total of 491 patients participated in the study, and the mean age of the patients was 67.51 years (SD = 5.84 years). Female patients represented 52.34% of total subjects. A total of 461 (around 94%) experienced at least one drug-related problem (DRP), ranging from one to nine DRPs per patient, with a total number of DRPs equal to 1625 identified. The most common DRP was the drug choice problem, affecting 52.98% of patients. Factors such as high drug frequency, living conditions, the number of diabetes medications, comorbidities, and smoking were significantly associated with higher numbers of DRPs. Higher numbers of DRPs were found to significantly worsen health-related quality of life (HRQoL) among patients. Conclusion: Geriatric individuals with type 2 diabetes mellitus encounter a significant prevalence of DRPs, with drug choice problems being the most common followed by dosing problems. Risk factors contributing to these DRPs include high drug frequency, living conditions, high number of diabetes medications, multimorbidity, and smoking. Also, the study concluded that the increased number of DRPs was associated with negative impact on HRQoL domains in geriatric patients with type 2 diabetes.