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Risk prediction of cardiovascular death based on the QTc interval

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Authors:
  • Nielsen, Jonas B ;
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    unknown
  • Graff, Claus ;
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    unknown
  • Rasmussen, Peter V ;
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    BSc + MSc programme, Faculty of Health and Medical Sciences, Københavns Universitet
  • Pietersen, Adrian ;
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    unknown
  • Lind, Bent ;
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    unknown
  • Olesen, Morten S ;
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    Molecular Cardiology and Membrane Proteins, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Københavns Universitet
  • Struijk, Johannes J ;
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    unknown
  • Haunsø, Stig ;
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    Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
  • Svendsen, Jesper H ;
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    Orcid logo0000-0001-8466-8515
    Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
  • Køber, Lars ;
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    Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
  • Gerds, Thomas A ;
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    Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
  • Holst, Anders G
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    Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
Subtitle:
evaluating age and gender differences in a large primary care population
DOI:
10.1093/eurheartj/ehu081
Abstract:
AIMS: Using a large, contemporary primary care population we aimed to provide absolute long-term risks of cardiovascular death (CVD) based on the QTc interval and to test whether the QTc interval is of value in risk prediction of CVD on an individual level. METHODS AND RESULTS: Digital electrocardiograms from 173 529 primary care patients aged 50-90 years were collected during 2001-11. The Framingham formula was used for heart rate-correction of the QT interval. Data on medication, comorbidity, and outcomes were retrieved from administrative registries. During a median follow-up period of 6.1 years, 6647 persons died from cardiovascular causes. Long-term risks of CVD were estimated for subgroups defined by age, gender, cardiovascular disease, and QTc interval categories. In general, we observed an increased risk of CVD for both very short and long QTc intervals. Prolongation of the QTc interval resulted in the worst prognosis for men whereas in women, a very short QTc interval was equivalent in risk to a borderline prolonged QTc interval. The effect of the QTc interval on the absolute risk of CVD was most pronounced in the elderly and in those with cardiovascular disease whereas the effect was negligible for middle-aged women without cardiovascular disease. The most important improvement in prediction accuracy was noted for women aged 70-90 years. In this subgroup, a total of 9.5% were reclassified (7.2% more accurately vs. 2.3% more inaccurately) within clinically relevant 5-year risk groups when the QTc interval was added to a conventional risk model for CVD. CONCLUSION: Important differences were observed across subgroups when the absolute long-term risk of CVD was estimated based on QTc interval duration. The accuracy of the personalized CVD prognosis can be improved when the QTc interval is introduced to a conventional risk model for CVD.
Type:
Journal article
Language:
English
Published in:
European Heart Journal, 2014, Vol 35, Issue 20, p. 1335-44
Keywords:
Age Factors; Aged; Aged, 80 and over; Cardiovascular Diseases; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Risk Assessment; Sex Factors; Journal Article; Research Support, Non-U.S. Gov't
Main Research Area:
Medical science
Publication Status:
Published
Review type:
Peer Review
Submission year:
2014
Scientific Level:
Scientific
ID:
261620515

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