ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
This article is part of the Research TopicSudden Cardiac Death: Mechanisms, Risk, and PreventionView all 8 articles
Tisdale-score-based risk stratification of QTc prolongations in hospitalized patients receiving azole antifungal therapy – a retrospective study
Provisionally accepted
- 1Hospital Pharmacy, LMU University Hospital, Munich, Germany
- 2Doctoral Program Clinical Pharmacy, LMU University Hospital, Munich, Germany
- 3Faculty of Medicine, LMU, Munich, Germany
- 4Department of Anesthesiology, LMU University Hospital, Munich, Germany
- 5Department of Cardiology, LMU University Hospital, Munich, Germany
- 6DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- 7Institute of Surgical Research at the Walter-Brendel-Center of Experimental Medicine, LMU University Hospital, Munich, Germany
- 8Member of the European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Munich, Germany
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Background QTc prolongation can trigger potentially lethal arrhythmias. Almost all azole antifungals, which are used in vulnerable patients, prolong the QTc interval and thus, may increase arrhythmia risk. The Tisdale-risk-score allows to identify patients at risk for drug-induced QTc prolongation but has not yet been investigated in this patient population. Objective To evaluate the sensitivity and specificity of the Tisdale-score with regard to detected QTc prolongations in patients prescribed systemic azole antifungals. Methods For six months (12/23-05/24), prescriptions of systemic azole antifungals were retrospectively recorded in adult inpatients of all medical specialties of a university hospital. Risk factors for QTc prolongation, including concomitant drugs and ECGs, were documented and the Tisdale-score and its sensitivity and specificity were calculated. Results In the study period, 319 systemic azole prescriptions (cases) were recorded for 259 patients. The median age of all cases was 61 years, 45% (143) were female. Including the systemic azole, a prescription of ≥2 QT-drugs was present in 283 (89%) cases. The median Tisdale-score was 7 (moderate risk). ECGs after azole initiation were available in 149 cases. Out of these, relevant QTc prolongations occurred in 7 cases (4.7%). Sensitivity of the Tisdale-score was 100%, specificity 30%. Conclusion Patients prescribed systemic azole antifungals are at risk of QTc prolongation due to regular use of multiple QT-drugs. However, relevant QTc prolongations were rare in the patient population studied. The Tisdale-score achieved a good sensitivity for the identification of patients at risk for QTc prolongation.
Keywords: Antifungal Agents, Critical Care, Long QT Syndrome, pharmaceutical care, Risk Assessment
Received: 13 Aug 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Steinbrech, Amann, Irlbeck, Clauss and Strobach. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Julian Steinbrech
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