Institution-Wide QT Alert System Identifies Patients With a High Risk of Mortality

被引:137
作者
Haugaa, Kristina H. [1 ]
Bos, J. Martijn [2 ]
Tarrell, Robert F. [3 ]
Morlan, Bruce W. [4 ]
Caraballo, Pedro J. [5 ]
Ackerman, Michael J. [1 ,6 ]
机构
[1] Mayo Clin, Div Cardiovasc Dis, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Mol Pharmacol & Expt Therapeut, Rochester, MN 55905 USA
[3] Mayo Clin, Dept Biomed Stat & Informat, Rochester, MN 55905 USA
[4] Mayo Clin, Div Hlth Care Policy & Res, Rochester, MN 55905 USA
[5] Mayo Clin, Div Gen Internal Med, Rochester, MN 55905 USA
[6] Mayo Clin, Div Pediat Cardiol, Rochester, MN 55905 USA
关键词
SUDDEN CARDIAC DEATH; INTERVAL; PROLONGATION; POPULATION; ARREST;
D O I
10.1016/j.mayocp.2013.01.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To determine the phenotype and outcome of patients with QTc of at least 500 ms and to create a pro-QTc risk score for mortality. Patients and Methods: An institution-wide computer-based QT alert system was developed and implemented at Mayo Clinic in Rochester, Minnesota. This system screens all electrocardiograms (ECGs) performed and alerts the physician if the QTc is 500 ms or greater. Between November 10, 2010, and June 30, 2011, 86,107 ECGs were performed in 52,579 patients. Clinical diagnoses, laboratory abnormalities, and medications known to influence the QT interval were collected from the medical records and summarized in a new pro-QTc score. Survival was compared with that of the 51,434 Mayo Clinic patients with a QTc less than 500 ms during the same period. Results: QT alerts were sent for 1145 patients (2%); of these, 470 (41%) had no other identifiable ECG reason for QT prolongation (eg, pacing). All-cause mortality during a mean +/- SD of 224 +/- 174 days of follow-up was 19% in those with QTc of 500 ms or greater compared with 5% in patients with QTc less than 500 ms (log-rank P<.001). The pro-QTc score was an age-independent predictor of mortality (pro-QTc score: hazard ratio, 1.18; 95% CI, 1.05-1.32; P=.006;age: hazard ratio, 1.02; 95% CI, 1.01-1.03; P=.004.). QT-prolonging medications accounted for 37% of the pro-QTc score. Conclusion: This novel institution-wide QT alert system identified patients with a high risk of mortality. The pro-QTc score, reflecting patients' multimorbidity and multipharmacy, was an independent predictor of mortality. The QT alert system may increase a physician's awareness of a high-risk patient. Potentially lifesaving interventions can be facilitated by reducing the modifiable factors of the pro-QTc score. (C) 2013 Mayo Foundation for Medical Education and Research square Mayo Clin Proc. 2013; 88(4): 315-325
引用
收藏
页码:315 / 325
页数:11
相关论文
共 20 条
[1]  
Bazett HC, 1920, HEART-J STUD CIRC, V7, P353
[2]   IMPROVED SEX-SPECIFIC CRITERIA OF LEFT-VENTRICULAR HYPERTROPHY FOR CLINICAL AND COMPUTER INTERPRETATION OF ELECTROCARDIOGRAMS - VALIDATION WITH AUTOPSY FINDINGS [J].
CASALE, PN ;
DEVEREUX, RB ;
ALONSO, DR ;
CAMPO, E ;
KLIGFIELD, P .
CIRCULATION, 1987, 75 (03) :565-572
[3]   In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs [J].
De Bruin, Marie L. ;
Langendijk, Pim N. J. ;
Koopmans, Richard P. ;
Wilde, Arthur A. M. ;
Leufkens, Hubert G. M. ;
Hoes, Arno W. .
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2007, 63 (02) :216-223
[4]   Heart rate-corrected QT interval prolongation predicts risk of coronary heart disease in black and white middle-aged men and women - The ARIC study [J].
Dekker, JM ;
Crow, RS ;
Hannan, PJ ;
Schouten, EG ;
Folsom, AR .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (04) :565-571
[5]   Prevention of Torsade de Pointes in Hospital Settings A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation [J].
Drew, Barbara J. ;
Ackerman, Michael J. ;
Funk, Marjorie ;
Gibler, W. Brian ;
Kligfield, Paul ;
Menon, Venu ;
Philippides, George J. ;
Roden, Dan M. ;
Zareba, Wojciech .
CIRCULATION, 2010, 121 (08) :1047-1060
[6]   Electrocardiogram interpreting technician: Training and role in a contemporary electrocardiogram practice [J].
Hammill, Stephen C. ;
Andrist, Edith M. ;
Thorkelson, Lois A. .
JOURNAL OF ELECTROCARDIOLOGY, 2008, 41 (05) :442-443
[7]   Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome [J].
Hobbs, Jenny B. ;
Peterson, Derick R. ;
Moss, Arthur J. ;
McNitt, Scott ;
Zareba, Wojciech ;
Goldenberg, Ilan ;
Qi, Ming ;
Robinson, Jennifer L. ;
Sauer, Andrew J. ;
Ackerman, Michael J. ;
Benhorin, Jesaia ;
Kaufman, Elizabeth S. ;
Locati, Emanuela H. ;
Napolitano, Carlo ;
Priori, Silvia G. ;
Towbin, Jeffrey A. ;
Vincent, G. Michael ;
Zhang, Li .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 296 (10) :1249-1254
[8]   Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population - A review and qualitative overview of the prospective cohort studies [J].
Montanez, A ;
Ruskin, JN ;
Hebert, PR ;
Lamas, GA ;
Hennekens, CH .
ARCHIVES OF INTERNAL MEDICINE, 2004, 164 (09) :943-948
[9]   Risk stratification in the long-QT syndrome [J].
Priori, SG ;
Schwartz, PJ ;
Napolitano, C ;
Bloise, R ;
Ronchetti, E ;
Grillo, M ;
Vicentini, A ;
Spazzolini, C ;
Nastoli, J ;
Bottelli, G ;
Folli, R ;
Cappelletti, D .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (19) :1866-1874