Electrocardiographic Predictors of Mortality: Data from a Primary Care Tele-Electrocardiography Cohort of Brazilian Patients
Gabriela M. M. Paixão,
Emilly M. Lima,
Paulo R. Gomes,
Derick M. Oliveira,
Manoel H. Ribeiro,
Jamil S. Nascimento,
Antonio H. Ribeiro,
Peter W. Macfarlane,
Antonio L. P. Ribeiro
Affiliations
Gabriela M. M. Paixão
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte 30130-100, Brazil
Emilly M. Lima
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte 30130-100, Brazil
Paulo R. Gomes
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte 30130-100, Brazil
Derick M. Oliveira
Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
Manoel H. Ribeiro
School of Computer and Communication Sciences, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
Jamil S. Nascimento
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte 30130-100, Brazil
Antonio H. Ribeiro
Department of Information Technology, Uppsala University, 752 37 Uppsala, Sweden
Peter W. Macfarlane
Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland G12 8QQ, UK
Antonio L. P. Ribeiro
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte 30130-100, Brazil
Computerized electrocardiography (ECG) has been widely used and allows linkage to electronic medical records. The present study describes the development and clinical applications of an electronic cohort derived from a digital ECG database obtained by the Telehealth Network of Minas Gerais, Brazil, for the period 2010–2017, linked to the mortality data from the national information system, the Clinical Outcomes in Digital Electrocardiography (CODE) dataset. From 2,470,424 ECGs, 1,773,689 patients were identified. A total of 1,666,778 (94%) underwent a valid ECG recording for the period 2010 to 2017, with 1,558,421 patients over 16 years old; 40.2% were men, with a mean age of 51.7 [SD 17.6] years. During a mean follow-up of 3.7 years, the mortality rate was 3.3%. ECG abnormalities assessed were: atrial fibrillation (AF), right bundle branch block (RBBB), left bundle branch block (LBBB), atrioventricular block (AVB), and ventricular pre-excitation. Most ECG abnormalities (AF: Hazard ratio [HR] 2.10; 95% CI 2.03–2.17; RBBB: HR 1.32; 95%CI 1.27–1.36; LBBB: HR 1.69; 95% CI 1.62–1.76; first degree AVB: Relative survival [RS]: 0.76; 95% CI0.71–0.81; 2:1 AVB: RS 0.21 95% CI0.09–0.52; and RS 0.36; third degree AVB: 95% CI 0.26–0.49) were predictors of overall mortality, except for ventricular pre-excitation (HR 1.41; 95% CI 0.56–3.57) and Mobitz I AVB (RS 0.65; 95% CI 0.34–1.24). In conclusion, a large ECG database established by a telehealth network can be a useful tool for facilitating new advances in the fields of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.
