QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department

Jennifer L. White, Anna Marie Chang, Judd E. Hollander, Erica Su, Robert E. Weiss, Annick N. Yagapen, Susan E. Malveau, David H. Adler, Aveh Bastani, Christopher W. Baugh, Jeffrey M. Caterino, Carol L. Clark, Deborah B. Diercks, Bret A. Nicks, Daniel K. Nishijima, Manish N. Shah, Kirk A. Stiffler, Alan B. Storrow, Scott T. Wilber, Benjamin Sun

Research output: Contribution to journalArticle

Abstract

Background: Syncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope. Methods: This is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451–470; 471–500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED. Results: The study cohort included 2609 patients. There were 1678 patients (64.3%) that had QTc intervals <451 ms; 544 (20.8%) were 451–470 ms; 302 (11.6%) were 471–500 ms, and 85 (3.3%) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0%, 15.3%, 18.2%, 22.4%, p = 0.01), but this association did not persist in multivariate analysis. Conclusions: In a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Syncope
Hospital Emergency Service
Electrocardiography
Bundle-Branch Block
Observational Studies
Cardiac Arrhythmias
Cohort Studies
Multivariate Analysis
Prospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

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QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department. / White, Jennifer L.; Chang, Anna Marie; Hollander, Judd E.; Su, Erica; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Clark, Carol L.; Diercks, Deborah B.; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

White, JL, Chang, AM, Hollander, JE, Su, E, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, DB, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, B 2018, 'QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department', American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2018.07.022
White, Jennifer L. ; Chang, Anna Marie ; Hollander, Judd E. ; Su, Erica ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Clark, Carol L. ; Diercks, Deborah B. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin. / QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department. In: American Journal of Emergency Medicine. 2018.
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abstract = "Background: Syncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope. Methods: This is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451–470; 471–500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED. Results: The study cohort included 2609 patients. There were 1678 patients (64.3{\%}) that had QTc intervals <451 ms; 544 (20.8{\%}) were 451–470 ms; 302 (11.6{\%}) were 471–500 ms, and 85 (3.3{\%}) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0{\%}, 15.3{\%}, 18.2{\%}, 22.4{\%}, p = 0.01), but this association did not persist in multivariate analysis. Conclusions: In a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.",
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T1 - QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department

AU - White, Jennifer L.

AU - Chang, Anna Marie

AU - Hollander, Judd E.

AU - Su, Erica

AU - Weiss, Robert E.

AU - Yagapen, Annick N.

AU - Malveau, Susan E.

AU - Adler, David H.

AU - Bastani, Aveh

AU - Baugh, Christopher W.

AU - Caterino, Jeffrey M.

AU - Clark, Carol L.

AU - Diercks, Deborah B.

AU - Nicks, Bret A.

AU - Nishijima, Daniel K.

AU - Shah, Manish N.

AU - Stiffler, Kirk A.

AU - Storrow, Alan B.

AU - Wilber, Scott T.

AU - Sun, Benjamin

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Syncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope. Methods: This is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451–470; 471–500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED. Results: The study cohort included 2609 patients. There were 1678 patients (64.3%) that had QTc intervals <451 ms; 544 (20.8%) were 451–470 ms; 302 (11.6%) were 471–500 ms, and 85 (3.3%) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0%, 15.3%, 18.2%, 22.4%, p = 0.01), but this association did not persist in multivariate analysis. Conclusions: In a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.

AB - Background: Syncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope. Methods: This is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451–470; 471–500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED. Results: The study cohort included 2609 patients. There were 1678 patients (64.3%) that had QTc intervals <451 ms; 544 (20.8%) were 451–470 ms; 302 (11.6%) were 471–500 ms, and 85 (3.3%) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0%, 15.3%, 18.2%, 22.4%, p = 0.01), but this association did not persist in multivariate analysis. Conclusions: In a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.

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DO - 10.1016/j.ajem.2018.07.022

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JF - American Journal of Emergency Medicine

SN - 0735-6757

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