Chest
Clinical InvestigationsCARDIOLOGYIs Telemetry Monitoring Necessary in Low-Risk Suspected Acute Chest Pain Syndromes?
Section snippets
Practice Setting
North Shore University Hospital is a 755-bed facility. It is a major cardiac referral center in the New York City metropolitan area. Cardiac monitoring occurs in all ICUs as well as two telemetry units (63 beds). Patients monitored on telemetry may be admitted through the emergency department, transferred from ICUs, as well as from general medical floors.
Heart rate and rhythm are transmitted continuously by two leads (aVL and V1) fashion. Technicians trained to recognize rhythm disturbances
Demographics
A total of 414 consecutive patients were evaluated during the course of the study (Table 1). The average (± SD) age was 67.8 ± 28.7 years. Of these, 191 patients (46.1%) were female and 223 patients (53.9%) were male. Two hundred ninety-four patients (71%) were white, and 39 patients (9.4%) were African American.
Cardiac History and Risk Factors
More than one third of patients had a history of coronary artery disease (n = 152, 36.7%): MI angiographically (n = 79) or on myocardial perfusion imaging (n = 56), or history of
Discussion
Based on initial ECG findings and history of presenting illness in patients suspected of acute coronary syndromes, it is possible to identify low-risk patients in whom telemetry monitoring does not appear to alter management. Its role should be reevaluated in these patients.
CCUs were introduced in the United States in the early 1960s in an attempt to lower the high mortality rate among hospitalized patients with AMI.2 Since then, it has been the standard of care in the United States to admit
Conclusion
Patients that present to the hospital with atypical chest pain and normal ECG findings are at low risk for life-threatening arrhythmias. In those who present without associated symptoms and with normal laboratory values, outpatient management can be considered an appropriate alternative to hospitalization.
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Cited by (37)
Lessons Learned from Efforts to Reduce Overuse of Cardiac Telemetry Monitoring
2020, Joint Commission Journal on Quality and Patient SafetyEmergency department monitor alarms rarely change clinical management: An observational study
2020, American Journal of Emergency MedicineImproving Value by Reducing Unnecessary Telemetry and Urinary Catheter Utilization in Hospitalized Patients
2017, American Journal of MedicineTelemetry Monitoring: Indications and Strategies to Reduce Overuse
2017, Hospital Medicine ClinicsOver-monitoring and alarm fatigue: For whom do the bells toll?
2013, Heart and Lung: Journal of Acute and Critical CareUnnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: Baseline results of the practical use of the latest standards for electrocardiography trial
2010, Journal of ElectrocardiologyCitation Excerpt :Although electrocardiographic (ECG) monitoring is the cornerstone of care in hospital cardiac units, few studies1-5 have evaluated how it is used.