Evidence base: A normal QT interval on electrocardiogram, corrected for heart rate (QTc) is <440 ms in men and <460 ms in women. Prolonged QTc, particularly >500 ms, increases risk of Torsade de Pointes and sudden cardiac death. Previous studies have shown a 35% prevalence of increased QTc in Emergency Departments, with 8% having a QTc >500 ms. QTc prolonging drugs are commonly prescribed in acutely unwell elderly inpatients who may also have QTc prolonging electrolyte abnormalities. We wished to review prevalence, staff knowledge, recognition and management of prolonged QTc in this group.
Change strategies: Part 1: November 2011, correspondence to Greater Glasgow and Clyde clinicians outlining risk of citalopram causing QTc prolongation and highlighting other culprit drugs.
Part 2: April 2012 departmental questionnaire of knowledge of QTc prolongation, n = 22.
Part 3: Education session to Department on QTc interval and causes of prolongation. Advised to review electrocardiogram QTc calculation.
Change effects: Following the above education a snapshot audit of 108 acute inpatients was performed to assess current practice; 68/108 (63%) were female. The mean age was 83 years (range 67–98).
Conclusion: Prolonged QTc is common in our patients but poorly documented. Medication, a modifiable risk factor, was a possible contributor in 12/28 (43%), but despite education was only recognised as such in 5/28 (18%). We suggest routine review of the readily available electrocardiogram QTc calculation, documentation of abnormal results and medication and electrolyte review. Further departmental education and audit is required.