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Utilization of Continuous Cardiac Monitoring on Hospitalist-led Teaching Teams
Debbie W Chen1, Robert Park1, Sarah Young1
1Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, USA.
Insights
Continuous cardiac monitoring (CCM) in general medical patients is often initiated for non-cardiac reasons like sepsis. A review found most patients on telemetry showed normal sinus rhythm, with few experiencing clinically significant arrhythmias.
Area of Science:
- Internal Medicine
- Cardiology
- Hospital Medicine
Background:
- Current guidelines for continuous cardiac monitoring (CCM) primarily address cardiac diagnoses.
- This limits the application of CCM in general medical patient populations.
Purpose of the Study:
- To review the reasons for initiating and maintaining CCM in general medical patients.
- To determine the incidence of clinically significant arrhythmias in this population.
Main Methods:
- Retrospective chart review of general medical patients on hospitalist-led teaching teams.
- Data collected from April 2017 to February 2018.
- Analysis of reasons for CCM initiation and duration, and incidence of arrhythmias.
Main Results:
- Sepsis (24%), arrhythmias (12%), and hypoxia (10%) were the most common reasons for CCM initiation.
- 62% of patients remained on CCM for over 48 hours; 39% until hospital discharge.
- 37% showed only normal sinus rhythm; only 3% had clinically significant arrhythmias affecting management.
Conclusions:
- CCM is frequently used in general medical patients for non-cardiac indications.
- A low incidence of clinically significant arrhythmias was observed in this population.
- Current CCM utilization may not align with established guidelines for general medical inpatients.
Abstract:
Guidelines for continuous cardiac monitoring (CCM) have focused almost exclusively on cardiac diagnoses, thus limiting their application to a general medical population. In this study, a retrospective chart review was performed to identify the reasons that general medical patients, cared for on hospitalist-led inpatient teaching teams between April 2017 and February 2018, were initiated and maintained on CCM, and to determine the incidence of clinically significant arrhythmias in this patient population. The three most common reasons for telemetry initiation were sepsis (24%), arrhythmias (12%), and hypoxia (10%). Most patients remained on telemetry for more than 48 hours (62%) and a significant number of patients were on telemetry until they were discharged from the hospital (39%). Of the cumulative total of more than 20,573 hours of CCM provided to this patient population, 37% of patients demonstrated only normal sinus rhythm and 3% had a clinically significant arrhythmia that affected management.
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