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Date of Graduation
It has been well established for decades that women are at increased risk for torsades de pointes (TdP). Additionally, it has been well documented that patients of lower socioeconomic status (SES) tend to have inferior health outcomes compared to other patient populations. In this study we investigate the incidence of iatrogenic in-hospital TdP among these two demographic groups. Iatrogenic in-hospital TdP is a complex combination of medical issues and including danger from QT prolonging medications. In theory, a combination of identifiable, demographic risk factors coupled with specific clinical settings could be used to identify patients at high risk for iatrogenic in-hospital TdP. We conducted a retrospective chart review of 457 inpatient electrophysiology consults. Factors reviewed included the presence of TdP, gender, presence of QT prolonging medication, and insurance status (as a marker of SES). Among all patients presenting with TdP (n = 23), female patients experienced a much higher rate than men, as 82.6% (P < 0.005) of in-hospital TdP cases were women. When focusing only on medication induced TdP, 83% (P < 0.005) of in-hospital TdP cases were women. SES (as measured by insurance status) was also strongly predictive of in-hospital TdP, as 39.1% (P = 0.01 – 0.005) of in-hospital TdP cases were in Medicaid/no insurance patients. Our data illustrates a clear female predominance of Iatrogenic in-hospital TdP rates. Regardless of gender, low SES is also a strong predictor of iatrogenic in-hospital TdP. This would suggest an opportunity to identify high risk patients sooner, lowering the rate of iatrogenic in-hospital TdP among these demographics.
Reinoehl, Bradley, "Gender and Socioeconomic Disparities in Iatrogenic In-Hospital Torsades de Points" (2020). Honors Theses. 3294.
Honors Thesis-Open Access