Assessment of Drug-Induced QTc Prolongation in Mental Health Practice: Validation of an Evidence-Based Algorithm

Abstract

Background

Drug-induced QTc interval prolongation (QTcIP) can lead to serious consequences and is often a concern for mental health practitioners, as access to experts such as cardiologists, for consultation is time-limiting and can delay treatment decisions. This research aimed at validating the content of an algorithm for the assessment, management and monitoring of drug-induced QTcIP in mental health practice.

Methods

Following an initial face validity by content experts, a cross-sectional survey of mental health care practitioners with a 4-point Likert-type scale was used to assess the validity of the decision steps on the QTcIP algorithm (QTcIPA) by estimating the content validity index (CVI) and the modified kappa statistic (κ*). Participants’ open-ended comments were also thematically analyzed.

Results

Mental health practitioners found the QTcIPA to be appropriate, safe, and evidence-based, as indicated by the high individual item CVI scores ranging from 0.89 to 1 for all of the steps/decision statements in the three domains assessed: appropriateness, safety and reliability of the references used. Five themes emerged from the qualitative analysis of the open-ended comments, of which three were identified as strengths, including practical usability, reliable references and beneficial for pharmacists. Two themes were recognized as limitations, namely, the need for additional clinical content and application barriers.

Conclusion

These results suggest that the QTcIPA may be a useful tool for mental health clinicians at the time of prescribing medications with potential risk of QTcIP. Future research will explore the implementation of the QTcIPA into clinical practice using computerized decision support tools through web-based and mobile applications.

Keywords:

• drug-induced arrhythmias
• QTc interval prolongation
• algorithm
• mental health practice
• clinical decision tool

Ethical Considerations

The study was conducted in Qatar with the approval of the Medical Research Committee at Hamad Medical Corporation with reference number: MRC-02-20-270, and Qatar University Institutional Review Board with reference number: QU-IRB 1295-EA/20. Participation consent was obtained via a checkbox at the start of the survey, which included the participant information sheet, where participants were ensured that they would not be identified by their name, and that all the information given would be confidential and reported as anonymous responses or as group data.

Acknowledgments

The authors would like to express their gratitude to all mental health practitioners who participated in this study for sharing their experiences on drug-induced QTcIP assessment, for reviewing the algorithm, and for providing their valuable feedback.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was made possible by the Undergraduate Research Experience Program (UREP) grant (UREP24-041-3-016) of the Qatar National Research Foundation and Qatar University Student Grant (QUST-2-CPH-2019-17). Publication funding was provided by Qatar University High Impact Grant (QUHI-CPH-23/24-161).