Electrocardiographic surveillance in a psychiatric institution: avoiding iatrogenic cardiovascular death

To describe a new initiative developed to optimise patient safety in a mental health setting in order to prevent serious cardiac events.

A longitudinal study of all in-patients admitted at the hospital, comprised of 197 beds distributed among three units, was conducted for 12 months. All admitted patients at the hospital underwent electrocardiogram surveillance, as it was described in our new local guideline for sudden cardiac death prevention. When electrocardiographic alterations were detected, treating physicians searched for patient's risk factors and suspicious medication and communicated the adverse event to the Pharmacy Department. These data were registered in electronic medical record system.

Over the 12-month study period, 225 patients were evaluated and 9 cases (4%) of long QT segment were detected. A multidisciplinary evaluation was done and it resulted in treatment modification and patient close monitoring. No sudden cardiac deaths occurred during the study period. Drugs more often involved in QT segment prolongation were: olanzapine, clomipramine, clozapine and risperidone.

QT segment interval enlargement is a frequent clinical problem that affects patients with mental pathology. This inexpensive initiative has allowed identifying patients at risk of sudden cardiac death and has helped to avoid mayor side effects.