Abstract
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
Published Version
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