Parivash Nourjah

Risk factors for prolonged QTc among US adults: Third National Health and Nutrition Examination Survey.

Background QT interval prolongation can lead to torsades de pointes, a potentially fatal arrhythmia. Although research exists on the relationship between QT prolongation and clinical outcome, few studies have described risk factors for prolonged QT interval in the general population. Methods The Third National Health and Nutrition Examination Survey (NHANES III) collected electrocardiogram interval data on 8561 subjects over 40 years of age and projected results to the US population. QT was corrected for heart rate using Fridericias formula. Logistic regression analyses were performed to identify factors independently associated with prolonged QTc interval, defined as being in the upper 5% of the population QTc interval distribution. Analyses were conducted separately for women and men as a result of differences in the QT distribution between the sexes and also because of potential effect modification. Analytical variables included age, race/ethnicity, electrolyte measurements, body mass index, the recent use of QT-prolonging drugs and past medical histories of stroke, thyroid disease, hypertension, diabetes and myocardial infarction. Results Age, female sex, hypocalcemia (men), hypokalemia (women), and a history of thyroid disease and myocardial infarction (men) were associated with a prolonged QTc interval. In addition, taking QT-prolonging medications in the past month was associated with more than a twofold increase in the odds of prolonged QTc interval in both men and women. Conclusions Healthcare practitioners should be aware that a prolonged QTc interval is a potential indicator of cardiovascular risk, and should exercise caution in prescribing potentially QT-prolonging medications to certain patients.

Study design for a comprehensive assessment of biologic safety using multiple healthcare data systems

Although biologic treatments have excellent efficacy for many autoimmune diseases, safety concerns persist. Understanding the absolute and comparative risks of adverse events in patient and disease subpopulations is critical for optimal prescribing of biologics.

Emergency department visits attributed to selected analgesics, United States, 2004-2005.

To estimate the rate of emergency department (ED) visits attributed to selected analgesic‐containing medications.

Drug-risk communication to pharmacists: Assessing the impact of risk-minimization strategies on the practice of pharmacy

OBJECTIVES To gain insight on the knowledge, opinions, barriers, and practices of pharmacists regarding drug risk-minimization tools. DESIGN Descriptive, nonexperimental, cross-sectional survey. SETTING 20 states in the United States, fall 2004. PARTICIPANTS 2,052 randomly selected licensed pharmacists employed in a position requiring an active pharmacist license at the time of the survey and who responded to the survey. INTERVENTION Participants completed a four-page survey regarding their experience with different types of risk-minimization tools. MAIN OUTCOME MEASURE Univariate distributions for each question were analyzed. RESULTS 50% of survey recipients responded to the mailing; 88% of respondents had an active pharmacist license. Of respondents, 18% reported never having received a Dear Healthcare Professional letter and 29% stated that they were not familiar with Medication Guides. Patient package inserts were thought to be somewhat effective by 53% of respondents. Of pharmacists who dispensed a drug with programs for special stickers to be affixed on prescriptions to indicate that the labeled risk had been addressed by the prescriber, 41% reported receiving a prescription without a sticker; 45% dispensed the prescription when stickers were missing. Sixty percent of pharmacists stated that risk-minimization programs have a negative impact on the daily practice of pharmacy; nevertheless, many acknowledged that it was a necessary duty. CONCLUSION Pharmacists might benefit from additional training on risk-minimization strategies. The successful implementation and impact of risk-minimization programs on the practice of pharmacy should be carefully considered by drug manufacturers and regulators.

Sex and Age Differences in Serum Potassium in the United States

An association between low serum potassium and prolongation of the electrocardiographic QT interval and cardiac arrhythmia has been known for some time (1)(2)(3). High serum potassium has also been found to be independently associated with increased cardiovascular mortality (4). However, population distributions of serum potassium have not been published recently, and as a result, physicians may not appreciate the prevalence of abnormal concentrations in the population. Knowledge of the prevalence of abnormal serum potassium concentrations is important when prescribing diuretics or drugs that are arrhythmogenic in the presence of hypo- or hyperkalemia. This report describes the distribution by age and sex of serum potassium concentrations in the US population and provides data on the prevalence of abnormal concentrations. The National Health and Nutrition Examination Survey (NHANES) is a nationwide probability sample of the noninstitutionalized civilian population of the US. NHANES has been conducted on a periodic basis since the early 1970s. Baseline data collection usually includes a medical history, standardized medical examination, dietary assessment, laboratory tests, and anthropometric measurements. Serum potassium was measured in participants of the third survey (NHANES III), which was performed during the period 1988–1994. Frozen sera were collected and sent for analyses to the CDC. Potassium values were obtained only …