Do QT-Prolonging Drugs Cause Major Adverse Cardiac Events in Hospitalized Adults?

This study's investigators have formed the largest hospital electronic medical record (EMR) research network in Canada to be able to address this important patient safety issue. The team's combined use of the Ontario GEMINI network and Epic-Dovetale EMR data has huge power because of the nearly 1 million patients, the rich data including medication exposure, outcomes and risk factor determination that is not available elsewhere, and the development of data structure that allows for future international collaborations. The investigators plan a nested case-control analysis using the Epic-Dovetale EMR and the GEMINI hospital electronic medical record (EMR) data repository (N \> 990,000 eligible adult patients) comparing patients with a MACE to those without a MACE and their relative exposure to one or more Known QTPmed during a hospitalization. In addition, the investigators will do time-varying estimates of the risk of MACE for those patients with periods of Known QTPmed exposure and non-exposure during the same hospitalization. The MACE primary outcome is a QTP-relevant composite of death, non-fatal cardiac arrest, ventricular arrhythmias, and syncope. A second analysis will use machine learning algorithms to predict QTPmeds-associated MACE and determine the relative importance of each predictor. This project will not only improve patient safety dramatically by improving the accuracy of QTPmeds-related alerts, it will also improve productivity and work satisfaction for thousands of healthcare providers internationally. In addition, the continued expansion and improvement of the largest Canadian hospital EMR research data platform is a huge new opportunity for future high-quality research.