Optimización de la seguridad del paciente cardíaco: Evaluación de la alerta de fármacos que prolonga el intervalo QT en prescripciones electrónicas en pacientes hospitalizados.
Villamañán E.1, Carpio C.3, Collada V.1, Sobrino C.1, Golovkina M.2, Ruano M.1, Armada E.4, Herrero A.1
1. Pharmacy Department. Hospital Universitario La Paz. IdiPAZ. Madrid, Spain
2. University of Wisconsin-Madison School of Pharmacy. Madison, United States
3. Pulmonology Department. Hospital Universitario La Paz. IdiPAZ. Madrid, Spain
4. Cardiology Department. Hospital Universitario La Paz. IdiPAZ. Madrid, Spain
Fecha de recepción: 26/10/2025 Fecha de aceptación: 12/12/2025
Abstract
Introduction: Prolongation of the QT interval is associated with severe ventricular arrhythmias and sudden cardiac death. Electronic prescribing systems may reduce inappropriate prescriptions of QT interval–prolonging drugs (QTIPD) by generating alerts during order entry.
Aim: The aim of this study was to evaluate prescribers’ awareness, opinions, and preferences regarding an electronic health record alert system for QTIPD.
Materials and Methods: A six-item questionnaire was distributed to attending physicians and medical residents from a tertiary hospital who regularly prescribe using the electronic health record. The questionnaire assessed awareness of the alert system, its use in clinical decision-making, and perceived usefulness. In addition, changes in the number of QTIPD prescriptions before and after alert implementation were analyzed.
Results: A total of 101 questionnaires were completed by 50 attending physicians and 51 residents from 20 different medical and surgical specialties. Most prescribers (84%) were aware of the alert system, and 78% reported that it prompted them to evaluate patients’ risk for QT interval prolongation. The alert was considered very useful by 61% of respondents and moderately useful by 37%. Furthermore, 86% of prescribers indicated they would like the system to suggest alternative non–QT-prolonging drugs.
A significant reduction in QTIPD prescriptions was observed after alert implementation, comparing the pre-alert period (before 2022) with the post-alert period (after 2023) (median 1,505 versus 1,335 prescriptions; p = 0.027). Haloperidol and clomipramine were the drugs with the greatest reduction in prescriptions.
Conclusion: Prescribers are generally familiar with and value QT alert systems, which support safer prescribing, particularly for neuroleptics and antidepressants, and contribute to improved patient safety overall.
Keywords: QT interval, long QT syndrome, alert system, electronic prescribing
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