How many patients need QT interval monitoring in critical care units? Preliminary report of the QT in Practice study.
Recent Scientific Statement from the American Heart Association (AHA) recommends that hospital patients should receive QT interval monitoring if certain conditions are present: QT-prolonging drug administration or admission for drug overdose, electrolyte disturbances (K, Mg), and bradycardia. No studies have quantified the proportion of critical care patients that meet the AHA's indications for QT interval monitoring. This is a prospective study of 1039 critical care patients to determine the proportion of patients that meet the AHA's indications for QT interval monitoring. Secondary aim is to evaluate the predictive value of the AHA's indications in identifying patients who actually develop QT interval prolongation.


METHODS
Continuous QT interval monitoring software was installed in all monitored beds (n = 154) across 5 critical care units. This system uses outlier rejection and median filtering in all available leads to construct an root-mean-squared wave from which the QT measurement is made. Fridericia formula was used for heart rate correction. A QT interval greater than 500 milliseconds for 15 minutes or longer was considered prolonged for analyses. To minimize false positives all episodes of QT prolongation were manually over read. Clinical data was abstracted from the medical record.


RESULTS
Overall 69% of patients had 1 or more AHA indications for QT interval monitoring. More women (74%) had indications than men (64%, P = .001). One quarter (24%) had QT interval prolongation (>500 ms for ≥15 minutes). The odds for QT interval prolongation increased with the number of AHA indications present; 1 indication, odds ratio (OR) = 3.2 (2.1-5.0); 2 indications, OR = 7.3(4.6-11.7); and 3 or more indications OR = 9.2(4.8-17.4). Positive predictive value of the AHA indications for QT interval prolongation was 31.2%; negative predictive value was 91.3%.


CONCLUSIONS
Most critically ill patients (69%) have AHA indications for QT interval monitoring. One quarter of critically ill patients (24%) developed QT interval prolongation. The AHA indications for QT interval monitoring successfully captured the majority of critically ill patients developing QT interval prolongation.
Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA. david.pickham@ucsf.edu
David
D
Pickham
Eric
E
Helfenbein
Julie A
JA
Shinn
Garrett
G
Chan
Marjorie
M
Funk
Barbara J
BJ
Drew
D002140:California; D003422:Critical Care / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008133:Long QT Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D018579:Patient Selection; D010865:Pilot Projects; D018570:Risk Assessment; D012307:Risk Factors