QT interval and short-term outcome in acute heart failure
Òscar Miró, Oriol Aguiló, Joan Carles Trullàs, Víctor Gil, Begoña Espinosa, Javier Jacob, Pablo Herrero, Josep Tost, María Luisa López‐Grima, Pere Comas, Carlos Bibiano, Lluís Llauger, Enrique Martín Mojarro, María Pilar López‐Díez, Julio Núñez, Zubaid Rafique, Kelly Rogers Keene, W. Frank Peacock, Pedro López‐Ayala, Christian Mueller, Manuel Montero Pérez‐Barquero, Lluı́s Mont, Pere Llorens, Marta Fuentes, Cristina Gil, Héctor Alonso, Enrique Pérez‐Llantada, Francisco Javier Martín‐Sánchez, Guillermo García, Mar Suárez Cadenas, Rosa Escoda, Sira Aguiló, Carolina Sánchez, Javier Millán, José Pavón, Antonio Noval, María Luisa López‐Grima, Amparo Valero, María Ángeles Juan, Alfons Aguirre, María Àngels Pedragosa, Silvia Mínguez Masó, María Isabel Alonso, Francisco Ruiz, José Miguel Franco, Ana Belén Mecina, Marta Berenguer, Ruxandra Donea, Susana Sánchez Ramón, Virginia Carbajosa Rodríguez, Pascual Piñera, José Andrés Sánchez Nicolás, Raquel Torres Gárate, Aitor Alquézar‐Arbé, Miguel Alberto Rizzi, Sergio Herrera, Álex Roset, Irene Cabello, Antonio Haro, Fernando Richard, José María Álvarez Pérez, Pablo Herrero, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González, Patricia Javaloyes, Inmaculada Mora-Jiménez, Néstor Hernández, Adriana Gil, Francisca Molina, Tamara García, Juan Antonio Andueza, Rodolfo Romero, Martín Ruíz, Roberto Calvache, María Teresa Lorca Serralta, Luis Ernesto Calderón Jave, Beatriz Amores Arriaga, Beatriz Sierra Bergua, Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez, Lisette Travería Bécquer, Guillermo Burillo, Lluís Llauger Garcia, Gerard Corominas LaSalle, Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial, Ester Soy Ferrer, María Adroher Múñoz, José Manuel Garrido, Francisco Javier Lucas-Imbernón, Rut Gaya, Carlos Bibiano, María Mir, Beatriz L. Rodríguez, José Luís Carballo, Esther Rodríguez‐Adrada, Belén Rodríguez Miranda
Abstract
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.