Inappropriate Prescribing

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Case Report

Drug-Induced Long-QT and Torsades de Pointes in Elderly Polymedicated Patients

Daniel García-Fuertes et al. Elena Villanueva-Fernández Manuel Crespín-Crespín

Introduction

Polymedication affects one in three patients older than 65 years. Its risks are widely known and are specially related to pharmacological interactions. One of these potential risks is the appearance of malignant ventricular arrhythmias when drugs that prolong QT interval are prescribed, including antibiotics, antidepressants, antiemetics, psychotropic medication or even antiarrhythmic drugs.^– The development of ventricular arrhythmias such asTorsades de Pointes (TdP), typically related to QT prolongation, is a potentially lethal complication. It is mandatory to recognize the drugs that can cause it, avoiding their joint use or planning a close monitoring in case their combination cannot be avoided.

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Original Article

I Brazilian Registry of Heart Failure – Clinical Aspects, Care Quality and Hospitalization Outcomes

Denilson Campos de Albuquerque et al. João David de Souza Neto Fernando Bacal Luiz Eduardo Paim Rohde … Sabrina Bernardez-Pereira Otavio Berwanger Dirceu Rodrigues Almeida Investigadores Estudo BREATHE

Background:

Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil.

Objective:

Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF.

Methods:

Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events.

Results:

A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included.

Conclusion:

The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.