Background: Studies addressing the utility of cardiac telemetry monitoring for patients hospitalized with COVID-19 pneumonia (PNA) is sparse. Patients hospitalized with COVID-19 PNA are at higher risk for cardiac complications (1-3), thus many hospitals instituted mandatory cardiac telemetry monitoring for patients hospitalized with COVID-19 PNA. However, there is scant data assessing the utility of cardiac telemetry monitoring in this patient population, specifically how monitoring informs patient management and is predictive of adverse outcomes.The goal of our current study is to determine if arrhythmias detected on cardiac telemetry are associated with adverse patient outcomes in patients hospitalized with a primary diagnosis of COVID-19 PNA.
Methods: Our study population consisted of all patients admitted with a primary diagnosis of COVID-19 PNA to our institution in the 10-month period between April 1, 2020, and December 31, 2020. We extracted cardiac telemetry data from our electronic medical record for all patients with COVID-19 PNA during the study period. The cardiac telemetry monitoring data categorized abnormal findings as follows: any tachyarrhythmia (sinus or supraventricular tachycardia), bradycardia, premature ventricular contractions, prolonged QTc ( 500ms), heart blocks and asystole ( 3 seconds). We defined an adverse patient outcome as any of the following during patients’ hospitalizations: length of stay 7-days, transfer to the intensive care unit, discharge with hospice care, or deceased. We first conducted a univariable analysis of variables potentially associated with adverse outcomes. In the multivariable analysis we included all patient demographic variables. We also included all clinical variables and cardiac telemetry variables with p-values of at least 0.2 in the univariable analysis. All analyses were performed using Stata/SE 16.1 (College Station, Tx).
Results: Our study population consisted of 462 patients admitted during the study period with all 462 study patients placed on cardiac telemetry monitoring. Over half (56.1%) of study patients experienced one or more arrhythmias on telemetry during their hospitalizations (Table 1). The most common arrhythmia was sinus bradycardia (32.7%) followed by any tachyarrhythmia (23.2%) and premature ventricular contractions (11.7%).In multivariable analyses (Table 2), increasing age (OR= 1.29, p < 0.001), hypoxia (OR= 3.55, p < 0.001) tachycardia (OR=2.56, p= 0.004), and bradycardia (OR=1.75, p= 0.041) on cardiac telemetry were significantly associated with adverse outcomes.
Conclusions: Our study demonstrates that detection of tachycardia or bradycardia cardiac monitoring, were predictive of adverse patient outcomes. This supports the hypothesis that cardiac telemetry monitoring provides additional prognostic information to clinicians caring for patient with COVID-19 PNA, above and beyond other clinical data such as age and hypoxia. Limitation of our study is that during the study period from April to December 2020 was early in the COVID-19 pandemic, the virulence and communicability of the prevalent COVID -19 strain at the time may be very different from current strains and therefore may not be applicable to current COVID-19 strains which have evolved over time. Future studies should focus on predictive value of telemetry monitoring based on current COVID-19 strains and how this has changed over time.
