National survey of cardiologists' standard of practice for continuous ST-segment monitoring
Kristin E Sandau1, Sue Sendelbach, Joel Frederickson
1Department of Nursing, Bethel University, St Paul, Minnesota 55113, USA. k-sandau@bethel.edu
Insights
Many cardiologists are unaware of ST-segment monitoring guidelines. Implementing hospital standards for continuous ST-segment monitoring can improve its use for cardiac patients.
Area of Science:
- Cardiology
- Medical Technology
- Clinical Practice
Background:
- Continuous ST-segment monitoring aids in early detection of transient cardiac ischemia.
- Guidelines recommend its use in specific patient populations, yet adoption in US hospitals is inconsistent.
Purpose of the Study:
- To assess cardiologists' awareness of continuous ST-segment monitoring guidelines.
- To evaluate their practice standards, patient selection, perceived benefits, barriers, and technology usefulness.
Main Methods:
- An electronic survey was distributed to 915 US cardiologists.
- Data were collected on awareness, practice standards, and perceptions of ST-segment monitoring.
Main Results:
- 55% of cardiologists were unaware of consensus guidelines for ST-segment monitoring.
- Only 49% of hospitals had a standard practice for its use.
- High agreement existed for monitoring in cardiovascular labs and ICUs; routine use was common for acute coronary syndrome and post-PCI patients.
- Hospital standards of practice and guideline awareness were linked to higher perceived benefits and use.
Conclusions:
- A significant portion of cardiologists lack awareness of published ST-segment monitoring guidelines.
- Hospital leadership can enhance awareness and adoption through evidence review and integrating monitoring into standard practices.
Background:
Continuous ST-segment monitoring can be used to detect early and transient cardiac ischemia. The American Heart Association and American Association of Critical-Care Nurses recommend its use among specific patients, but such monitoring is routine practice in only about half of US hospitals.
Objective:
To determine cardiologists' awareness and practice standards regarding continuous ST-segment monitoring and the physicians' perceptions of appropriate patient selection, benefits and barriers, and usefulness of this technology.
Methods:
An electronic survey was sent to a random sample of 915 US cardiologists from a pool of 4985 certified cardiologists.
Results:
Of 200 responding cardiologists, 55% were unaware of the consensus guidelines. Of hospitals where respondents admitted patients, 49% had a standard of practice for using continuous ST-segment monitoring for cardiac patients. Most cardiologists agreed or strongly agreed that patients in the cardiovascular laboratory (87.5%) and intensive care unit (80.5%) should have such monitoring. Cardiologists routinely ordered ST monitoring for patients with acute coronary syndrome (67%) and after percutaneous coronary intervention (60%). The primary factor associated with higher perceptions for benefits, clinical usefulness, and past use of continuous ST-segment monitoring was whether or not hospitals in which cardiologists practiced had a standard of practice for using this monitoring. A secondary factor was awareness of published consensus guidelines for such monitoring.
Conclusion:
Respondents (55%) were unaware of published monitoring guidelines. Hospital leaders could raise awareness by multidisciplinary review of evidence and possibly incorporating continuous ST-segment monitoring into hospitals' standards of practice.
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