Background:
Cardiac monitoring has become increasingly available in noncritical beds. Most clinicians assume that this practice enhances patient care and improves outcomes, but such benefits have not been systematically proven. In 2004, the American Heart Association (AHA) published practice standards that included expert opinions regarding indications for electrocardiographic monitoring in hospital settings. However, there is still variable understanding of how to optimally use this often limited resource. The objective of this study was to determine the proportion of patients admitted to the telemetry unit who have class 1 indications based on the AHA recommendations and to determine the rate of significant cardiac events during the monitoring period.
TABLE Distribution of Patients Admitted to the Telemetry Unit
Methods:
The electronic medical records of all admissions to the telemetry unit of a community hospital for the month of January 2009 were reviewed. The indications for admission were classified based on the AHA practice standards. Class 1 includes clinical conditions in which cardiac monitoring is indicated in most, if not all, patients in the group; class 2 is when cardiac monitoring may be of benefit for some patients but is not considered essential for all patients; and class 3 is when cardiac monitoring is not indicated because a patient's risk of a serious event is so low that monitoring has no therapeutic benefit. The occurrences of new significant cardiac events during the period of monitoring were recorded, such as acute coronary syndrome, symptomatic or malignant arrhythmias, QT prolongation, and sudden cardiac death.
Results:
Of the 158 admissions to the telemetry unit that were reviewed, 111 (70%) met class 1 indications based on AHA recommendations, and 47 (30%) did not. Seven of the 111 (6.3%) developed a significant cardiac event during the telemetry stay; including 3 patients who were diagnosed with acute myocardial infarction (AMI) after presenting in the emergency department with chest pain and 2 patients who died from sudden cardiac death after being admitted for an AMI and for acute heart failure. Nobody in the group who did not meet class 1 indications developed a significant cardiac event.
Conclusions:
Physicians overestimate the role of telemetry in guiding patient management in the non–intensive care setting. The AHA practice standards appear to provide safe and effective guidance on selecting patients for cardiac monitoring in the hospital. Larger prospective studies are needed to further strengthen this decision‐support tool.
Disclosures:
A. Haddad ‐ none; D. Paje ‐ none; W. Bisset ‐ none; Y. Hwang ‐ none; H. Gunderson ‐ none