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To the Editor: Although the concept of a prolonged QRS duration having prognostic value, as raised in the study by Dr Wang and colleagues,¹ is both logical and appealing, there are a number of features of this study that require it to be interpreted with caution.

First, the authors chose to retain covariates in the multivariate model if they met P < .05 for all-cause mortality. This is not an optimal approach,² particularly in observational studies in which it is critical to include all covariates that are clinically important. The presentation is unclear regarding which covariates were actually used and whether the same method for covariate selection was applied to all analyses.

Second, for QRS prolongation to be a target for therapy, patients who entered the hospital with a QRS interval of 120 milliseconds or longer and left it with a QRS less than 120 milliseconds should have a better prognosis . . . [Full Text of this Article]

Peter Höglund, MD, PhD
peter.hoglund@skane.se

L. A. Fredrik Nilsson, PhD
Competence Centre for Clinical Research
Lund University Hospital
Lund, Sweden

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