Screening entire healthcare system ECG database: Association of deep terminal negativity of P wave in lead V1 and ECG referral with mortality

Allison Junell, Jason Thomas, Lauren Hawkins, Jiri Sklenar, Trevor Feldman, Charles Henrikson, Larisa Tereshchenko

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    Background Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population. Objective To evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population. Methods Retrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from − 100 μV to − 200 μV) and ZeroPpV1 (Pp = 0). An entire healthcare system (2010–2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter–defibrillator were excluded. DTNPV1 (n = 3,413) and ZeroPpV1 (n = 3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y. Results DTNPV1 was associated with all-cause mortality (HR 1.95(1.64–2.31); P < 0.0001) and newly diagnosed AFib (HR 1.29(1.04–1.59); P = 0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34% relative risk reduction of mortality (HR 0.66(0.52–0.84); P = 0.001), as compared to ECG referral by a non-cardiologist. Conclusion DTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.

    Original languageEnglish (US)
    Pages (from-to)219-224
    Number of pages6
    JournalInternational Journal of Cardiology
    Volume228
    DOIs
    StatePublished - Feb 1 2017

    Fingerprint

    Electrocardiography
    Referral and Consultation
    Databases
    Delivery of Health Care
    Mortality
    Atrial Fibrillation
    Atrial Flutter
    Sudden Cardiac Death
    Cardiovascular Diseases
    Tertiary Healthcare
    Risk Reduction Behavior
    Lead
    Population
    Medical Records
    Comorbidity
    Cause of Death
    Cohort Studies
    Cardiologists

    Keywords

    • Electrocardiogram
    • Health system
    • Mortality
    • Patient education

    ASJC Scopus subject areas

    • Medicine(all)
    • Cardiology and Cardiovascular Medicine

    Cite this

    Screening entire healthcare system ECG database : Association of deep terminal negativity of P wave in lead V1 and ECG referral with mortality. / Junell, Allison; Thomas, Jason; Hawkins, Lauren; Sklenar, Jiri; Feldman, Trevor; Henrikson, Charles; Tereshchenko, Larisa.

    In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 219-224.

    Research output: Contribution to journalArticle

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    abstract = "Background Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population. Objective To evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population. Methods Retrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from − 100 μV to − 200 μV) and ZeroPpV1 (Pp = 0). An entire healthcare system (2010–2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter–defibrillator were excluded. DTNPV1 (n = 3,413) and ZeroPpV1 (n = 3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y. Results DTNPV1 was associated with all-cause mortality (HR 1.95(1.64–2.31); P < 0.0001) and newly diagnosed AFib (HR 1.29(1.04–1.59); P = 0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34{\%} relative risk reduction of mortality (HR 0.66(0.52–0.84); P = 0.001), as compared to ECG referral by a non-cardiologist. Conclusion DTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.",
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    T2 - Association of deep terminal negativity of P wave in lead V1 and ECG referral with mortality

    AU - Junell, Allison

    AU - Thomas, Jason

    AU - Hawkins, Lauren

    AU - Sklenar, Jiri

    AU - Feldman, Trevor

    AU - Henrikson, Charles

    AU - Tereshchenko, Larisa

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    N2 - Background Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population. Objective To evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population. Methods Retrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from − 100 μV to − 200 μV) and ZeroPpV1 (Pp = 0). An entire healthcare system (2010–2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter–defibrillator were excluded. DTNPV1 (n = 3,413) and ZeroPpV1 (n = 3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y. Results DTNPV1 was associated with all-cause mortality (HR 1.95(1.64–2.31); P < 0.0001) and newly diagnosed AFib (HR 1.29(1.04–1.59); P = 0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34% relative risk reduction of mortality (HR 0.66(0.52–0.84); P = 0.001), as compared to ECG referral by a non-cardiologist. Conclusion DTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.

    AB - Background Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population. Objective To evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population. Methods Retrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from − 100 μV to − 200 μV) and ZeroPpV1 (Pp = 0). An entire healthcare system (2010–2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter–defibrillator were excluded. DTNPV1 (n = 3,413) and ZeroPpV1 (n = 3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y. Results DTNPV1 was associated with all-cause mortality (HR 1.95(1.64–2.31); P < 0.0001) and newly diagnosed AFib (HR 1.29(1.04–1.59); P = 0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34% relative risk reduction of mortality (HR 0.66(0.52–0.84); P = 0.001), as compared to ECG referral by a non-cardiologist. Conclusion DTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.

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    KW - Health system

    KW - Mortality

    KW - Patient education

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