Screening entire health system ecg databases to identify patients at increased risk of death

David G. Strauss, Nathan Mewton, Richard L. Verrier, Bruce D. Nearing, Francis E. Marchlinski, Tony Killian, John Moxley, Larisa G. Tereshchenko, Katherine C. Wu, Raimond Winslow, Christopher Cox, Peter M. Spooner, João A.C. Lima

    Research output: Contribution to journalArticle

    19 Scopus citations

    Abstract

    Background-Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction =35%, miss ̃80% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS-scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization-repolarization relationship) have high 1-year all-cause mortality and could be further risk stratified with clinical characteristics. Methods and Results-We screened all 12-lead ECGs over 6 months at 2 large hospital systems and analyzed clinical characteristics and 1-year mortality. Patients with ECGs obtained in hospital areas with known high mortality rates were excluded. At the first hospital, QRS-score =5 and QRS-T angle =105° identified 8.0% of patients and was associated with an odds ratio of 2.79 (95% confidence interval, 2.10-3.69) for 1-year mortality compared with patients below both ECG thresholds (13.9% versus 5.5% death rate). Left ventricular ejection fraction was >35% in 82% of the former group of patients, and addition of ECG measures to left ventricular ejection fraction increased the discrimination of death risk (P<0.0001). At the second hospital, the odds ratio was 2.42 (1.95-3.01) for 1-year mortality (8.8% versus 3.8%). Adjustment for patient characteristics eliminated interhospital differences. Multivariable adjusted odds ratio combining data from both hospitals was 1.53 (1.28-1.83). Increasing heart rate and chronic renal impairment further predicted mortality. Conclusions-Screening hospital ECG databases with QRS-scoring and QRS-T angle analysis identifies patients with high 1-year all-cause mortality and predominantly preserved left ventricular ejection fraction. This approach may represent a widely available method to identify patients at increased risk of death.

    Original languageEnglish (US)
    Pages (from-to)1156-1162
    Number of pages7
    JournalCirculation: Arrhythmia and Electrophysiology
    Volume6
    Issue number6
    DOIs
    StatePublished - Dec 2013

    Keywords

    • Arrhythmias
    • Cardiac
    • Death
    • Electrocardiography
    • Fibrosis
    • Mass screening

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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  • Cite this

    Strauss, D. G., Mewton, N., Verrier, R. L., Nearing, B. D., Marchlinski, F. E., Killian, T., Moxley, J., Tereshchenko, L. G., Wu, K. C., Winslow, R., Cox, C., Spooner, P. M., & Lima, J. A. C. (2013). Screening entire health system ecg databases to identify patients at increased risk of death. Circulation: Arrhythmia and Electrophysiology, 6(6), 1156-1162. https://doi.org/10.1161/CIRCEP.113.000411