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Datapoints: Prevalence of QT Prolongation Among Veterans With Severe Mental Illness
Eileen M. Stock, Ph.D.; Laurel A. Copeland, Ph.D., M.P.H.; Ruth L. Bush, M.D., M.P.H.; John E. Zeber, Ph.D., M.H.A.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201300212
View Author and Article Information

Except for Dr. Bush, the authors are affiliated with the Center for Applied Health Research, which is jointly sponsored by the Central Texas Veterans Health Care System and Scott & White Healthcare, 2102 Birdcreek Dr., Temple, TX 76502 (e-mail: eileen.stock@va.gov). All authors are affiliated with Texas A&M Health Science Center, Bryan, Texas. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.

Copyright © 2013 by the American Psychiatric Association

The QT interval refers to the time required for the heart to repolarize after ventricular depolarization. The U.S. Food and Drug Administration (FDA) has issued Drug Safety Communications on drugs associated with QT prolongation and fatal ventricular arrhythmias. Antidepressants received attention after the 2011 FDA communication on citalopram, often prescribed off-label for posttraumatic stress disorder (PTSD).

Aggregated data (diagnosis codes and outpatient prescriptions) were examined for all Veterans Health Administration (VHA) patients treated between October 2005 and September 2009. Among 7.1 million patients, 1,224 had a diagnosis of QT prolongation (ICD−9 code 426.82). Chi square tests assessed the association of prior-year severe mental illness with QT prolongation.

Among patients with QT prolongation, the mean age was similar to that for all VHA patients (about 61 years). However, rates of severe mental illness were higher (28% versus 12% for all VHA patients). Risk factors for QT prolongation included gender (35 females versus 16 males per 100,000) and African-American race (31 per 100,000 versus 20 for all patients). QT prolongation among patients with severe mental illness was nearly triple that among patients without severe mental illness (40 per 100,000 versus 14), and it was elevated for specific illnesses (Figure 1). Citalopram was prescribed to 8% of the study sample, more commonly for patients with PTSD (16%) or major depression (21%). Receipt of any drug associated with QT prolongation varied by illness: without severe mental illness, 14%; schizophrenia, 20%; PTSD, 24%; and major depression, 28%.

 
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Figure 1Prevalence of QT prolongation among Veterans Health Administration patients, October 2005 to September 2009a

a95% confidence intervals reported in parentheses. PTSD, posttraumatic stress disorder

Findings highlight the need to reevaluate types and combinations of medications that may potentiate heart disease or death among patients with severe mental illness. A study limitation is that the data precede the 2011–2012 FDA Drug Safety Communications, and citalopram use may change in the wake of the warnings.

The study was supported by grant IIR-09-335 from VA Health Services Research and Development. The views do not necessarily represent those of the Department of Veterans Affairs.

The authors report no competing interests.

Figure 1 Prevalence of QT prolongation among Veterans Health Administration patients, October 2005 to September 2009a

a95% confidence intervals reported in parentheses. PTSD, posttraumatic stress disorder

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