In patients with acute heart failure, a prolonged QTc interval > 561 ms on the initial emergency department ECG was associated with an increased risk of 30-day all-cause mortality (OR 1.86).
Cohort (n=1,800)
Yes
Does corrected QT (QTc) interval duration predict short-term outcomes including 30-day mortality and hospitalization in patients with acute heart failure?
In patients presenting to the emergency department with acute heart failure, a prolonged QTc interval (>561 ms) on the initial ECG is an independent predictor of 30-day mortality.
Effect estimate: OR 1.86 (95% CI 1.00-3.45)
OBJECTIVE: To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF). METHODS: We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with pace-maker rhythm were excluded. Primary outcome was 30-day all-cause mortality and secondary outcomes were need of hospitalization, in-hospital mortality and prolonged hospitalization (> 7 days). Association between QTc and outcomes was explored by restricted cubic spline (RCS) curves. Results were expressed as odds ratios (OR) and 95%CI adjusted by patients baseline and decompensation characteristics, using a QTc = 450 ms as reference. RESULTS: Of 1800 patients meeting entry criteria (median age 84 years (IQR = 77-89), 56% female), their median QTc was 453 ms (IQR = 422-483). The 30-day mortality was 9.7%, while need of hospitalization, in-hospital mortality and prolonged hospitalization were 77.8%, 9.0% and 50.0%, respectively. RCS curves found longer QTc was associated with 30-day mortality if > 561 ms, OR = 1.86 (1.00-3.45), and increased up to OR = 10.5 (2.25-49.1), for QTc = 674 ms. A similar pattern was observed for in-hospital mortality; OR = 2.64 (1.04-6.69), for QTc = 588 ms, and increasing up to OR = 8.02 (1.30-49.3), for QTc = 674 ms. Conversely, the need of hospitalization had a U-shaped relationship: being increased in patients with shorter QTc OR = 1.45 (1.00-2.09) for QTc = 381 ms, OR = 5.88 (1.25-27.6) for the shortest QTc of 200 ms, and also increasing for prolonged QTc OR = 1.06 (1.00-1.13), for QTc = 459 ms, and reaching OR = 2.15 (1.00-4.62) for QTc = 588 ms. QTc was not associated with prolonged hospitalization. CONCLUSION: In ED AHF patients, initial QTc provides independent short-term prognostic information, with increasing QTc associated with increasing mortality, while both, shortened and prolonged QTc are associated with need of hospitalization.
Miró et al. (2023) conducted a cohort in Acute heart failure (n=1,800). Prolonged QTc interval (> 561 ms) vs. QTc = 450 ms was evaluated on 30-day all-cause mortality (OR 1.86, 95% CI 1.00-3.45). In patients with acute heart failure, a prolonged QTc interval > 561 ms on the initial emergency department ECG was associated with an increased risk of 30-day all-cause mortality (OR 1.86).