Which QT Correction Formulae to Use for QT Monitoring?

J Am Heart Assoc. 2016 Jun 17;5(6):e003264. doi: 10.1161/JAHA.116.003264.


Background: Drug safety precautions recommend monitoring of the corrected QT interval. To determine which QT correction formula to use in an automated QT-monitoring algorithm in our electronic medical record, we studied rate correction performance of different QT correction formulae and their impact on risk assessment for mortality.

Methods and results: All electrocardiograms (ECGs) in patients >18 years with sinus rhythm, normal QRS duration and rate <90 beats per minute (bpm) in the University Hospitals of Leuven (Leuven, Belgium) during a 2-month period were included. QT correction was performed with Bazett, Fridericia, Framingham, Hodges, and Rautaharju formulae. In total, 6609 patients were included (age, 59.8±16.2 years; 53.6% male and heart rate 68.8±10.6 bpm). Optimal rate correction was observed using Fridericia and Framingham; Bazett performed worst. A healthy subset showed 99% upper limits of normal for Bazett above current clinical standards: men 472 ms (95% CI, 464-478 ms) and women 482 ms (95% CI 474-490 ms). Multivariate Cox regression, including age, heart rate, and prolonged QTc, identified Framingham (hazard ratio [HR], 7.31; 95% CI, 4.10-13.05) and Fridericia (HR, 5.95; 95% CI, 3.34-10.60) as significantly better predictors of 30-day all-cause mortality than Bazett (HR, 4.49; 95% CI, 2.31-8.74). In a point-prevalence study with haloperidol, the number of patients classified to be at risk for possibly harmful QT prolongation could be reduced by 50% using optimal QT rate correction.

Conclusions: Fridericia and Framingham correction formulae showed the best rate correction and significantly improved prediction of 30-day and 1-year mortality. With current clinical standards, Bazett overestimated the number of patients with potential dangerous QTc prolongation, which could lead to unnecessary safety measurements as withholding the patient of first-choice medication.

Keywords: QT interval electrocardiography; electrocardiography; mortality; population; risk factors; risk prediction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arrhythmias, Cardiac / chemically induced
  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / physiopathology
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Electrocardiography / standards
  • Electrophysiologic Techniques, Cardiac / standards
  • Female
  • Heart Rate / physiology
  • Humans
  • Long QT Syndrome / chemically induced
  • Long QT Syndrome / diagnosis
  • Long QT Syndrome / physiopathology
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Risk Assessment