Research Profiles

"Background: Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for almost one-third of the total global deaths. Early CVD risk assessment and management (RAM) has demonstrated to be effective in decreasing CVD-related burden. However, CVDRAM services face many challenges and barriers in the community. Mobile technology has been advocated to facilitate access to CVDRAM for both healthcare providers and patients to overcome these barriers. Nevertheless, there is limited availability and use of CVDRAM-related mobile technology in the Middle East region.

Objectives: To implement an English and Arabic version of a mobile and web application for CVDRAM in both, community pharmacies and selected primary health care centers (PHCCs) in Qatar.

Methodology: A prospective observational study (QCARxE) is underway to explore the feasibility of using the ERC in patients accessing primary health care services for CVDRAM, including community pharmacies and primary health care centers (PHCC).

Results: To date, a total of 36 patients have enrolled in the QCARxE study (20 from PHCC and 16 from community pharmacies). At their initial CVD risk assessment visit, the mean CVD risk score for these patients was 28.3%, and the most prevalent risk factor was obesity (mean BMI = 30.2 kg/m²).

Conclusion: Preliminary data derived from the QCARxE study indicates a significant proportion of patients accessing primary health care services are at high CVD risk. It is speculated that the use of the ERC will enable patients to become better aware of their CVD risk and improve access to risk factor interventions."

"Prolongation of the QTc interval (QTcI) is a concern for all clinicians as it can be followed by a life threatening polymorphic ventricular tachyarrhythmia called torsades de pointes (TdP). The potential risk of TdP raises concerns among health care providers when prescribing medications that can prolong QTcI, particularly in patients who may be predisposed. In daily practice, because of an ever-increasing number of medications available and other non-drug factors that must be accounted for, clinicians may face difficulties on how to assess, manage, monitor or refer patients at risk of drug-induced QTcI prolongation. The psychiatric population appears to be particularly vulnerable to these types of adverse events, due to polypharmacy and because many psychotropic medications are known to prolong the QTcI. To address this, an algorithm was developed based on an extensive literature review of the latest available guidelines for the assessment, monitoring and management of drug-induced QTcI prolongation. The steps on this algorithm were tested by experts in the field of cardiology and mental health, showing strong content validity.

This project will aim at transforming this validated QTc algorithm into a web-based electronic clinical decision support (ECDS) application to help clinicians in non-acute health care settings improve clinical decision making at the time of prescribing. This project will facilitate further integration of this application into clinical information systems (CISs) in tertiary health care. Improving the ability of health care professionals providing care to patients with mental illness who may be at higher risk of QTcI prolongation through the integration of ECDS into their practice will facilitate further integration of mental health services in Qatar, a key priority of the National Health Strategy 2018-2022 and the Qatar National Vision 2030."

"Phase I:
Background: QTc interval (QTcI) prolongation leads to serious complications, making it a concern for clinicians. Assessing the risk of QTcI prolongation in the psychiatric population is important because they are exposed to multiple medications known to increase the risk of life-threatening arrhythmias.

Objectives: The study aims to validate the content of an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population.

Methodology: Qualitative semi-structured interviews of cardiologists, to gather information regarding their approach in assessing the risk of drug-induced QTc prolongation at the time of prescribing. After the interview, an orientation to the algorithm was provided with a link to a cross-sectional, anonymous survey. The online survey included quantitative and qualitative components to gather feedback on the relevance and appropriateness of each step in the algorithm.

Results: Interview responses were incorporated into 4 themes. Responses indicated a lack of a unified protocol when assessing QTcI prolongation, which supports the need of an algorithm that includes a verified risk scoring tool. Quantitative survey results showed a mean score ranging from 3.08 to 3.67 out of 4 for the appropriateness of the algorithm's steps, 3.08 to 3.58 for the safety and 3.17 to 3.75 for the reliability of references used. Additional analysis using the modified kappa and I-CVI statistical measures indicate high validity of contents and high degree of agreement between raters. As per the open-ended questions, cardiologists supported the implementation of the algorithm; however, they recommended simplification of the steps as they appear to be cumbersome.

Conclusion: The results demonstrate that the implementation of the algorithm after minor alterations can prove to be useful as a tool for the risk assessment of QTc prolongation. Further validation of the algorithm with mental health pharmacists and clinicians will be conducted as a separate phase of the study.

Phase II:
Background: Drug-induced QTc prolongation (QTcP) can lead to serious consequences, and is often a concern for mental health practitioners as access to experts, such as cardiologists, for consultation is time-limiting and can delay treatment decisions.

Objectives: This research aimed at validating the content of an algorithm for the assessment, management and monitoring of drug-induced QTcP in the psychiatric population.

Methodology: This is part two of a two-phase investigation which evaluated the appropriateness, safety and evidence to support the decision steps in the QTcP algorithm (QTcPA), using both, quantitative [surveys of health practitioners to assess the content validity index (CVI)], and qualitative (thematic analysis of feedback provided by mental health practitioners on the QTcPA). CVI for the steps and decision processes in the QTcPA were calculated from responses to the surveys.

Results: Cardiology experts and mental health practitioners found the QTcPA to be appropriate, safe, and evidence based as indicated by the CVI scores and reliability ratings of the references used in its development. Individual item-CVI analysis indicated high validity of the QTcPA as it scored 0.89 to 1 for all of the steps/decision statements in the three aspects assessed: appropriateness, safety, and reliability of the references used. The analysis of participant feedback on the QTcI Prolongation Algorithm revealed the emergence of five themes. Among these themes, three were identified as strengths, including practical usability, reliable references, and the benefits for pharmacists. Two themes were recognized as limitations, namely the need for additional clinical content and perceived barriers. Overall, the themes provide positive feedback on the algorithm's use, highlighting the potential for modifications to enhance its effectiveness.

Conclusion: These results suggest that the QTcPA may be a useful tool for clinicians to use at the time of prescribing drugs with a risk of QTcP. Future research will explore the implementation of the QTcPA into clinical practice using computerized decision support tools through web-based and mobile applications. "

"Background: Cardiovascular disease (CVD) risk assessment and management (RAM) services face many challenges and barriers in the community. Mobile technology offers the opportunity to empower patients and improve access to health prevention strategies to overcome these barriers. However, there is limited information on the availability and use of CVDRAM-related mobile technology in the Arabic language.

Objectives: To pilot test an Arabic version of a CVDRAM application among potential end-users accessing community pharmacy services in Qatar.

Methodology: Translation of an established cardiovascular risk calculator (EPI·RxISK™) into the Arabic language was conducted. The English/Arabic version of the calculator was tested by potential end-users, consisting of a sample of community pharmacists (CRxs) and members of the public (MOP) accessing community pharmacy services. Semi-structured interviews were conducted based on the quality attributes of the Mobile Application Rating Scale (MARS). Data were analyzed using deductive content analysis.

Results: A total of 10 CRxs and 5 MOP were interviewed. Five themes emerged to describe the EPI·RxISK™ calculator: Engagement, Functionality, Attractiveness, Education, and Responsiveness. For the most part, positive subthemes were associated with each of these themes. The functionality and educational themes had some negative subthemes.

Conclusion: End-users of the EPI·RxISK™ calculator had mostly positive descriptors that were aligned with all five quality attributes of the web and mobile applications."