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Incidence and outcomes of long QTc in acute medical admissions

Mahmud, R, Gray, A, Nabeebaccus, A and Whyte, MB (2018) Incidence and outcomes of long QTc in acute medical admissions International Journal of Clinical Practice, 72 (11), e13250. pp. 1-8.

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Abstract

Aims

Prolonged QT interval on electrocardiogram (ECG) increases the risk of ventricular arrhythmia. Patients admitted to acute medical units (AMU) may be at risk of QT prolongation from multiple, recognised risk factors. Few data exist regarding incidence or outcomes of QT prolongation in acute general medical admissions. The aims were to determine the incidence of Bazett’s-corrected QT (QTc) prolongation upon admission to AMU; the relationship between QTc and inpatient mortality, length of stay and readmission; proportion with prolonged QTc subsequently administered QT interval-prolonging drugs.

Methods

Retrospective, observational study of 1000 consecutive patients admitted to an AMU in a large urban hospital. Exclusion criteria: age ˂18 years, ventricular pacing, poor quality/absent ECG. QTc determined manually from ECG obtained within 4-hours of admission. QTc prolongation considered ≥470 ms (males) and ≥480 ms (females). In both genders ˃500 ms was considered severe. Study endpoints, (i) incidence of QTc prolongation at admission; (ii) inpatient mortality, length of stay and readmission rates; (iii) proportion with QTc prolongation subsequently administered QT intervalprolonging drugs.

Results

Of 1000 patients, 288 patients were excluded, therefore final sample was n=712. Patient age (mean ± SD) was 63.1 ± 19.4 years; females 49%. QTc prolongation was present in n=50 (7%) at admission; 1.7% had QTc interval ˃500ms. Of the 50 patients admitted with prolonged QTc, 6 (12%) were subsequently administered QT interval-prolonging drugs. QTc prolongation was not associated with worse inpatient mortality or readmission rate. Length of stay was greater in those with prolonged QTc, 7.2 (IQR 2.4-13.2) days vs 3.3 (IQR 1.3-10.0; P=0.004), however in a regression model, presence of QTc did not independently affect length of stay.

Conclusions

QTc interval prolongation is frequent among patients admitted to AMU. QT interval-prolonging drugs are commonly prescribed to patients presenting with prolonged QTc but whether this affects clinical outcomes is uncertain.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Mahmud, R
Gray, A
Nabeebaccus, A
Whyte, MBm.b.whyte@surrey.ac.uk
Date : 17 September 2018
DOI : 10.1111/ijcp.13250
Copyright Disclaimer : This is the peer reviewed version of the following article: Mahmud, R, Gray, A, Nabeebaccus, A and Whyte, MB (2018) Incidence and outcomes of long QTc in acute medical admissions International Journal of Clinical Practice, 72 (11), e13250, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.13250. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Uncontrolled Keywords : QTc, Bazett, drugs, admissions, polypharmacy
Depositing User : Melanie Hughes
Date Deposited : 23 Aug 2018 13:09
Last Modified : 18 Sep 2019 02:08
URI: http://epubs.surrey.ac.uk/id/eprint/849075

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