Search

OBJECTIVES Pharmacogenomic testing (PGX) implementation is rapidly expanding, including pre-emptive testing funded by health systems. PGX continues to develop an evidence base that it saves money and improves clinical outcomes. Identifying the potential impact of pre-emptive testing in specific populations may aid in the development of a business case. METHODS We utilized a software tool that can evaluate patient drug lists and identified groups of patients most likely to benefit from implementation of a PGX testing program in a major medical system population. RESULTS Medication lists were obtained for sixteen patient groups with a total of 82 613 patients. The percent of patients in each group with testing 'Recommended', 'Strongly recommended', or 'Required' ranged from 12.7% in the outpatient pediatric psychiatry group to 75.7% in the any adult inpatient age >50 years group. Some of the highest yield drugs identified were citalopram, simvastatin, escitalopram, metoprolol, clopidogrel, tramadol, and ondansetron. CONCLUSION We demonstrate a significant number of patients in each group may have benefit, but targeting certain ones for pre-emptive testing may result in the initial highest yield for a health system.

Introduction: Torsades de pointes (TdP) is a life-threatening arrhythmia associated with prolongation of the heart rate-corrected QT (QTc) interval. QTc prolongation is associated with increased mortality. A QTc Risk Score (QTc-RS) advisory has been developed, but the ability of the QTc-RS to predict mortality is unknown. Objective: To evaluate the relationship between a validated QTc-RS and mortality among hospitalized patients. Methods: An advisory incorporating a previously validated QTc-RS was implemented as a clinical decision support tool at 28 inpatient facilities. When an order was initiated for a known QTc-prolonging medication, a QTc-RS (maximum score = 21) was electronically calculated and, if the score was > 11, prescribers received a warning that included patient-specific risk factors. The advisory also provided single click actions for laboratory tests, electrocardiogram orders, cancelling incoming medication orders or discontinuing existing QTc-prolonging medications. Results: Between April and November 2020, there were 144,148 QTc-RS scores calculated. Among the 7923 warnings with a score >11, the majority (51%) had a score of 12, 29% had a score of 13, 12% had a score of 14, and 8% had a score ≥ 15. The most common risk factors were: age > 67 years (66%); sepsis (65%); ≥ 1 QTc-prolonging medication(s) (60%); female (59%); heart failure (34%); serum potassium < 3.5 mEq/L (28%); and a loop diuretic (21%). Among those with a QTc-RS >11, 11.9% (944/7923) expired during the inpatient encounter. The proportion of deaths increased as the risk score increased (Table 1). Relative to individuals with QTc-RS 12-14, the odds ratio for inpatient mortality in those with scores >17 was 3.0 (95% CI:1.7-5.5). Conclusions: An increasing QTc-RS was associated with an increased likelihood of in-hospital mortality