Chest
Clinical InvestigationsCARDIOLOGYCongestive Heart Failure and QRS Duration: Establishing Prognosis Study
Section snippets
Setting
The target population was derived from the Resource Utilization Among Congestive Heart Failure (REACH) study, which has been recently reported.23 Briefly, Henry Ford Hospital is a 903-bed tertiary care center located in the Detroit metropolitan area and receives patients whose care is provided primarily within the Henry Ford Health System (HFHS), a vertically integrated, mixed-model managed-care organization that includes urban and suburban satellite clinics in Southeast Michigan. The CONQUEST
Baseline Characteristics
The target population of 3,471 patients with echocardiographic and ECG data were followed up for an average of 32.4 months (Table 1). The average index age was 66.1 years, with 1,723 men (49.6%), 1,748 women (50.4%), 1,429 white subjects (41.2%), and 1,925 black subjects (55.5%). The average QRS duration of the population was 104 ms, and 721 patients were identified with a QRS duration ≥ 120 ms. Overall, there were 1,798 deaths (51.8%).
Epidemiology of QRS Prolongation
The prevalence of systolic dysfunction was analyzed for
Discussion
This study highlights the determinants and utility of QRS duration in the general CHF population. In a prior data validation set, the positive predictive value of the ICD-9-CM coding was 73.8% when chart analysis was performed using both Framingham criteria and National Health and Nutritional Examination Survey-I criteria for CHF.2829 This is similar to the positive predictive value found in a previously published report.30 The most common cause of CHF in this set was caused by ischemic causes,
Conclusion
A prolonged QRS duration can be expected in 20% of a generalized heart failure population. Determinants for a prolonged QRS duration are male sex, white race, elderly age groups, and patients with systolic dysfunction. When compared with patients with a normal QRS duration, those patients with the most extreme QRS prolongation have improved survival, whereas patients with intermediate prolongation of the QRS complex (120 to 149 ms) have worse survival. Also, systolic dysfunction seems to have a
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Presented in part at the American College of Chest Physicians, CHEST 2000, October 22–26, 2000, San Francisco, CA, and the American Heart Association, 73rd Annual Scientific Session, November 11–15, 2000, Atlanta, GA.