CredibleMeds.org: What does it offer?

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Abstract

Since the 1990s, when numerous non-cardiac drugs were first recognized to have the potential to prolong the QT interval and cause torsades de pointes (TdP), clinicians, drug regulators, drug developers, and clinical investigators have become aware of the complexities of assessing evidence and determining TdP causality for the many drugs being marketed or under development. To facilitate better understanding, the Arizona Center for Education and Research on Therapeutics, known as AZCERT, has developed the CredibleMeds.org website which includes QTdrugs, a listing of over 220 drugs placed in four risk categories based on their association with QT prolongation and TdP. Since the site was launched in 1999, it has become the single and most reliable source of information of its kind for patients, healthcare providers, and research scientists. Over 96,000 registered users rely on the QTdrugs database as their primary resource to inform their medication use, their prescribing or their clinical research into the impact of QT-prolonging drugs and drug-induced arrhythmias. The QTdrugs lists are increasingly used as the basis for clinical decision support systems in healthcare and for metrics of prescribing quality by healthcare insurers. A free smartphone app and an application program interface enable rapid and mobile access to the lists. Also, the CredibleMeds website offers numerous educational resources for patients, educators and healthcare providers that foster the safe use of medications.

Introduction

The CredibleMeds.org website is a unique resource for anyone seeking reliable information regarding the many drugs known to prolong the QT interval and cause the potentially lethal arrhythmia, torsades de pointes (TdP) [1]. In the 16 years since its launch, the website has grown from a simple list of drugs that cause TdP to a valuable clinical and research resource for patients, healthcare providers, and research scientists. The website was created by AZCERT, one of a network of 14 federally funded Centers for Education and Research on Therapeutics (CERTs) created to improve health outcomes from therapeutics [2], [3]. Initially based at the University of Arizona, AZCERT has focused on identifying drugs and drug-drug interactions that are responsible for QT prolongation and TdP. In 2012, AZCERT transitioned from a university-based program to a free-standing non-profit 501(c)3 corporation, now funded by the US Food and Drug Administration, research grants, and charitable contributions. AZCERT and its CredibleMeds website are recognized as the singular international resource for reliable, up to date, and independent information on medications, especially those associated with QT prolongation and/or TdP [1]. To prevent real or perceived bias in assessing QT or TdP causality for drugs, AZCERT does not accept funding from companies that have a commercial interest in medications.

Section snippets

What CredibleMeds.org offers

AZCERT curates and posts on the CredibleMeds website list of drugs based on their risk of TdP. The “QTdrugs” list includes all drugs that can affect the QT interval in humans and therefore have some risk of TdP. This list includes three subcategories of drugs, that is, those with Known Risk of TdP, those with Possible Risk of TdP, and those with Conditional Risk of TdP. The website also posts another list, drugs to avoid in patients with congenital long QT syndrome (CLQTS), which includes all

For Everyone: QTdrugs lists (registration required)

Under a contract with the U.S. Food and Drug Administration's Safe Use Initiative, AZCERT curates and posts on the CredibleMeds website lists of drugs that are associated with TdP and/or QT prolongation, commonly referred to as the QTdrugs lists [4]. The continually updated lists are currently accessed by over 96,000 registered visitors from 193 countries. Fifty six percentage of the registrants are healthcare providers, 39% are other individuals, and 5% are research scientists. A survey of

AZCERT's scientific review of drugs

Medications are evaluated for their association with drug-induced QT prolongation or TdP by a Scientific Review Committee with three physician members (R.L.W., C.W.H., and K.R.). The committee's decisions and recommendations for placement of drugs into TdP risk categories are reviewed by an International Advisory Board of 39 recognized authorities on drug safety and cardiovascular medicine (https://www.crediblemeds.org/research-scientists/advisory-board/).

AZCERT developed the process for

For Everyone: Create “My Medicines” online lists

To address one of the most challenging aspects of therapeutics, AZCERT has created an online repository for patients to create and maintain a list of the medicines they are taking. The user is prompted to remember to include hormones, vitamins, non-prescription medicines and dietary supplements. When creating the medicines list, the program informs the user if any drug they enter is in one of the four TdP risk categories and it will subsequently inform the user by e-mail if one of the drugs

Role of CredibleMeds in clinical decision support systems

The overall goal of the CredibleMeds website is to foster and support efforts to prevent TdP. Consensus papers have defined what actions are required for prevention of TdP but successful implementation requires that physicians be able to manage massive amounts of information about the drugs and about their patients [19]. This has prompted scientists to develop Clinical Decision Support Systems (CDSS) to help physicians and other members of the health care team to reach optimal medical and

References (25)

  • P.J. Schwartz et al.

    Predicting the unpredictable: drug-induced QT prolongation and torsades de pointes

    J Am Coll Cardiol

    (2016)
  • K.H. Haugaa et al.

    Institution-wide QT alert system identifies patients with a high risk of mortality

    Mayo Clin Proc

    (2013)
  • E. Poluzzi et al.

    Drug-induced arrhythmia: bridging the gap between pathophysiological knowledge and clinical practice

    Drug Saf

    (2017)
  • R.L. Woosley

    Centers for education and research in therapeutics

    Clin Pharmacol Ther

    (1994)
  • R.L. Woosley

    Centers for education and research in therapeutics

    Pharmacologist

    (1998)
  • P.G. Postema et al.

    Safe drug use in long QT syndrome and Brugada syndrome: comparison of website statistics

    Europace

    (2013)
  • R.L. Woosley et al.

    Adverse Drug Event Causality Analysis (ADECA): a process for evaluating evidence and assigning drugs to risk categories for sudden death

    Drug Saf

    (2017)
  • A.B. Hill

    The environment and disease: association or causation?

    Proc R Soc Med

    (1965)
  • J. Almenoff et al.

    Perspectives on the use of data mining in pharmaco-vigilance

    Drug Saf

    (2005)
  • P.J. Schwartz et al.

    The long QT syndrome: a transatlantic clinical approach to diagnosis and therapy

    Eur Heart J

    (2013)
  • S.M. Al-Khatib et al.

    What clinicians should know about the QT interval

    J Am Med Assoc

    (2003)
  • N.M. LaPointe et al.

    Knowledge deficits related to the QT interval could affect patient safety

    Ann Noninvasive Electrocardiol

    (2003)
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    The authors have indicated there are no conflicts of interest.

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