• David Pickham, Eric Helfenbein, Julie A Shinn, Garrett Chan, Marjorie Funk, Ann Weinacker, Jia-Ni Liu, and Barbara J Drew.
• Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA. david.pickham@ucsf.edu
• Crit. Care Med.. 2012 Feb 1;40(2):394-9.

ObjectiveTo test the potential value of more frequent QT interval measurement in hospitalized patients.DesignWe performed a prospective, observational study.SettingAll adult intensive care unit and progressive care unit beds of a university medical center.PatientsAll patients admitted to one of six critical care units over a 2-month period were included in analyses.InterventionsAll critical care beds (n = 154) were upgraded to a continuous QT monitoring system (Philips Healthcare).Measurements And Main ResultsQT data were extracted from the bedside monitors for offline analysis. A corrected QT interval >500 msecs was considered prolonged. Episodes of QT prolongation were manually over-read. Electrocardiogram data (67,648 hrs, mean 65 hrs/patient) were obtained. QT prolongation was present in 24%. There were 16 cardiac arrests, with one resulting from Torsade de Pointes (6%). Predictors of QT prolongation were female sex, QT-prolonging drugs, hypokalemia, hypocalcemia, hyperglycemia, high creatinine, history of stroke, and hypothyroidism. Patients with QT prolongation had longer hospitalization (276 hrs vs. 132 hrs, p < .0005) and had three times the odds for all-cause in-hospital mortality compared to patients without QT prolongation (odds ratio 2.99 95% confidence interval 1.1-8.1).ConclusionsWe find QT prolongation to be common (24%), with Torsade de Pointes representing 6% of in-hospital cardiac arrests. Predictors of QT prolongation in the acutely ill population are similar to those previously identified in ambulatory populations. Acutely ill patients with QT prolongation have longer lengths of hospitalization and nearly three times the odds for mortality then those without QT prolongation.

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