Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities

Malinda S Tan; C William Heise; Tyler Gallo; James E Tisdale; Raymond L Woosley; Corneliu C Antonescu; Sheila M Gephart; Daniel C Malone

doi:10.1016/j.jelectrocard.2022.11.008

Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities

J Electrocardiol. 2023 Mar-Apr:77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008. Epub 2022 Dec 9.

Authors

Malinda S Tan¹, C William Heise², Tyler Gallo³, James E Tisdale⁴, Raymond L Woosley⁵, Corneliu C Antonescu⁶, Sheila M Gephart⁷, Daniel C Malone⁸

Affiliations

¹ Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
² Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.
³ Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, AZ, USA.
⁴ Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN, USA; Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, IN, USA.
⁵ Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Arizona Center for Education and Research on Therapeutics (AZCERT), Tucson, AZ, USA.
⁶ BannerHealth, Greeley, CO, USA.
⁷ Community and Health Systems Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA.
⁸ Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. Electronic address: Dan.Malone@utah.edu.

PMID: 36527915
DOI: 10.1016/j.jelectrocard.2022.11.008

Abstract

Objectives: To evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS) and inpatient mortality and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP).

Background: Managing the risk of TdP is challenging due to the number of medications with known risk of TdP and the complexity of precipitating factors. A model to predict risk of mortality may be useful to guide treatment decisions.

Methods: This was a retrospective observational study using inpatient data from 28 healthcare facilities in the western United States. This risk score ranges from zero to 23 with weights applied to each risk factor based on a previous validation study. Logistic regression and a generalized linear model were performed to assess the relationship between QTc-RS and mortality and length of stay.

Results: Between April and December 2020, a QTc-RS was calculated for 92,383 hospitalized patients. Common risk factors were female (55.0%); age > 67 years (32.1%); and receiving a medication with known risk of TdP (24.5%). A total of 2770 (3%) patients died during their hospitalization. Relative to patients with QTc-RS < 7, the odds ratio for mortality was 4.80 (95%CI:4.42-5.21) for patients with QTc-RS = 7-10 and 11.51 (95%CI:10.23-12.94) for those with QTc-RS ≥ 11. Length of hospital stay increased by 0.7 day for every unit increase in the risk score (p < 0.0001).

Conclusion: There is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.

Keywords: Arrhythmias; Cardiac; Mortality; Torsades de pointes.

Publication types

Observational Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Aged
DNA-Binding Proteins
Electrocardiography
Female
Humans
Inpatients
Long QT Syndrome* / etiology
Male
Risk Factors
Torsades de Pointes* / etiology

Substances

DNA-Binding Proteins

Grants and funding

R18 HS026662/HS/AHRQ HHS/United States