Abstract
Since the development of coronary care units (CCUs), telemetry has rapidly become the standard of care in evaluating patients with suspected acute coronary syndromes, regardless of the probability for ischemia. However, there is no data to support this practice. Our objective was to evaluate the utility of routine cardiac monitoring in a chest pain observation unit. We prospectively studied the utility of routine cardiac monitoring in 249 consecutive patients admitted to an observation unit in an academic Emergency Department over a 6-month period. All the patients presented with chest pain thought to be cardiac ischemia. Observation included serial cardiac enzymes, ECG cardiac monitoring, and exercise testing in a designated chest pain observation unit. These patients were determined to be at low risk for an acute coronary event by two criteria: first, the symptoms had resolved by the time of observation unit admission, and second, the initial ECG was normal, unchanged or non-diagnostic for acute ischemia. Adverse outcomes included cardiac arrest, hospital admission secondary to cardiac dysrhythmia, or alteration in the patient’s medical therapy upon discharge from the observation unit, secondary to cardiac dysrhythmia. There were 249 patients included with a median age of 52 with 60% women. Fifteen percent of the patients were, subsequently, admitted to the hospital for further evaluation of ischemia based on enzyme, ECG, and exercise testing results. One patient with known Tachy-Brady syndrome was noted to have 1.5–2 s pauses while sleeping, and discharged with instructions to hold beta blocker therapy pending results of a continuous loop recorder. Of the remaining 248 patients, no patient suffered a cardiac arrest, no patient was admitted to the hospital secondary to cardiac dysrhythmia, and no alteration in a patient’s medical therapy was made secondary to cardiac dysrhythmia. No patient returned to the Emergency Department within 72 h with cardiac arrest, acute dysrhythmia or acute myocardial infarction. Although telemetry may be the standard of care in evaluating the patients with suspected acute coronary syndromes, regardless of the probability of an acute ischemic syndrome, in those patients with a normal or non diagnostic ECG and resolved symptoms, routine cardiac monitoring is unnecessary.
Similar content being viewed by others
References
Hollander JE, Sites FD, Pollack CV et al (2004) Lack of utility of telemetry monitoring for identification of cardiac death and life-threatening ventricular dysrhythmias in low-risk patients with chest pain. Ann Emerg Med 43:71–76
Hollander JE, Valentine SM, McCuskey C et al (1997) Are monitored telemetry beds necessary for patients with nontraumatic chest pain and normal or nonspecific electrocardiograms? Am J Cardiol 79:1110–1111
Estrada CA, Prasad NK, Rosman HS et al (1994) Outcomes of patients hospitalized to a telemetry unit. Am J Cardiol 74:357–362
Estrada CA, Rosman HS, Prasad NK et al (1995) Role of telemetry monitoring in the non-intensive care unit. Am J Cardiol 76:960–965
Schull MJ, Redelmeier DA (2000) Continuous electrocardiographic monitoring and cardiac arrest outcomes in 8, 932 telemetry ward patients. Acad Emerg Med 7:647–652
Kelly AM, Kerr D (2001) It is safe to manage selected patients with acute coronary syndromes in unmonitored beds? J Emerg Med 21:227–233
Atzema C, Schull MJ, Borgundvaag B et al (2006) ALARMED: adverse events in low-risk patients with chest pain receiving continuous electrocardiographic monitoring in the emergency department: a pilot study. Am J Emerg Med 24:62–67
Gatien M, Perry JJ, Stiell IG (2007) A clinical decision rule to identify which chest pain patient scan safely be removed from cardiac monitoring in the emergency department. Ann Emerg Med 50:136–143
Goldman L, Cook EF, Johnson PA et al (1996) Prediction of the need for intensive care in patients who come to emergency departments with acute pain. N Engl J Med 334:1498–1504
Chen EH, Judd E, Hollander JE (2007) When do patients need admission to a telemetry bed? J Emerg Med 33:53–60
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grossman, S.A., Shapiro, N.I., Lawrence Mottley, J. et al. Is telemetry useful in evaluating chest pain patients in an observation unit?. Intern Emerg Med 6, 543–546 (2011). https://doi.org/10.1007/s11739-011-0648-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-011-0648-x