Background: Prolongation of the QT interval is associated with adverse cardiac events, mainly a distinctive ventricular tachycardia known as Torsades de Pointes. Prolonged QT can be congenital or acquired and is OFTEN measured as a corrected QT interval of >450 msec for men and >470 msec for women. In a world where medical knowledge and treatment options are expanding at an exponential rate, the implications of prolonged QTc in INTERNAL medicine is becoming increasingly important. There are over 170 mediations that have a known, possible, or conditional risk for prolonged QT interval. This study assesses internal medicine (IM) providers’ knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT.
Methods: A 17-question, anonymous survey was constructed and distributed to IM providers and residents at a tertiary care center in the Midwest. Questions included demographic information, 6 Likert-scale questions gauging provider exposure and comfort with prolonged QT, and 10 multiple choice clinical vignettes written by a clinical cardiologist and clinical pharmacist. These covered knowledge of risk factors that prolonged QT, medications that prolong QT, and treatment of congenital and acquired prolonged QT. Data was analyzed by evaluating trends and using means to determine provider comfort with prolonged QT identification and treatment. Knowledge was assessed via clinical vignettes and compared by level of training.
Results: 45 responses were received – 18/52 IM providers and 24/35 IM residents. Overall response rate was 48%. ~70% of respondents see patients with acquired prolonged QT once monthly or less. 95% rarely see congenital prolonged QT. When presented with prolonged QT, 73% of providers seldom or sometimes consulted pharmacy, 99% seldom or never consulted cardiology, and ~50% sometimes used online resources. The average number correct on the clinical vignettes was 5.59/10, with the highest scores seen in attending physicians in their first five years of practice (6.96/10). In general, attending physicians were more familiar with medications prolonging QT while residents were more familiar with risk factors prolonging QT.
Conclusions: This study revealed gaps in education when it comes to prolongation of the QT interval, particularly when taking care of patients with multiple co-morbidities and extensive medication lists. Providers rarely saw patients with congenital prolonged QTc and were not as familiar with treatment. Future directions include surveying more providers at an academic institution to improve the power of this study and make further recommendations regarding education on prolonged QT. Educational opportunities could include an online module or grand rounds presentation.