Wendl Elizabeth, Telles Nelson, Wall Geoff C
Department of Medical Education, Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, IA 50311, United States.
Department of Cardiology, Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, IA 50311, United States.
World J Cardiol. 2021 Mar 26;13(3):42-45. doi: 10.4330/wjc.v13.i3.42.
Prolongation of the QT interval is associated with adverse cardiac events specifically Torsades de pointes (TdP). There are multiple mediations that have a known, possible, or conditional risk for prolonged QT interval, but general practitioners' knowledge of these medications is unknown. We conducted a survey to assess 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. A 17-question, anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care center. Questions included demographic information, 6 Likert-scale questions gauging provider experience with prolonged QT, and 10 multiple choice clinical vignettes to assess clinical knowledge. Data was analyzed descriptively. Knowledge was assessed clinical vignettes and compared by level of training. Forty-one responses were received out of a total of 87 possible respondents (47.1% response rate). About 70% of respondents see patients with acquired prolonged QT once monthly or more. 95% rarely see congenital prolonged QT. When presented with QTc drug issues, 73% of providers seldom or sometimes consulted pharmacy, but about half used online resources. The average correct score 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). Our survey suggests that IM providers commonly encounter QT prolonging drugs. Educational efforts to improve knowledge of drug and patient risk factors for TdP may be needed.
QT间期延长与不良心脏事件相关,特别是尖端扭转型室速(TdP)。有多种药物具有已知、可能或有条件的导致QT间期延长的风险,但全科医生对这些药物的了解情况尚不清楚。我们进行了一项调查,以评估内科(IM)医疗服务提供者对与QT延长相关的风险因素和药物的了解,以及在治疗QT延长患者时的经验和舒适度。2019年设计了一项包含17个问题的匿名调查,并分发给一家三级医疗中心的IM医疗服务提供者和住院医师。问题包括人口统计学信息、6个衡量医疗服务提供者处理QT延长经验的李克特量表问题,以及10个用于评估临床知识的多项选择题临床病例。对数据进行描述性分析。通过临床病例评估知识,并按培训水平进行比较。在总共87名可能的受访者中收到了41份回复(回复率为47.1%)。约70%的受访者每月或更频繁地诊治获得性QT延长患者。95%的受访者很少见到先天性QT延长患者。当遇到QTc药物问题时,73%的医疗服务提供者很少或有时会咨询药剂科,但约一半的人会使用在线资源。临床病例的平均正确得分是5.59/10,得分最高的是从业头五年的主治医师(6.96/10)。我们的调查表明,IM医疗服务提供者经常遇到可延长QT的药物。可能需要开展教育活动,以提高对TdP药物和患者风险因素的认识。