Yield of Continuous Cardiac Monitoring in Pre-Specified Low-Risk Patients: A Retrospective Cohort Study

The aim of this study was to quantify the yield of continuous cardiac monitoring (CCM) in patients with pre-specified low-risk criteria, including those with mildly elevated troponin levels.

This was a retrospective cohort study of patients admitted to the ward from the emergency department (ED) with CCM. The primary outcome was the occurrence of clinically relevant arrhythmia. The secondary outcome was immediately life-threatening arrhythmia. Sub-group analyses were performed for patients presenting with chest pain, with initial mildly elevated and negative troponin levels.

Of 1639 patients who were admitted to the ward from the ED with CCM, 403 met pre-specified low-risk criteria. Of those 403 patients, there were 16 (3.96%; 95% CI: 1.52%-6.38%) patients who had clinically relevant arrhythmia, and none had a critical arrhythmia. Among the subgroup of 84 patients presenting with chest pain who had a mildly elevated initial troponin, there was one clinically relevant arrhythmia (1.19%; 95% CI 0.00%-3.53%), and among the 174 patients presenting with chest pain and a negative troponin, there were five who had clinically relevant arrhythmia (2.94%; 95% CI: 0.44%-5.44%).

CCM in pre-specified low-risk patients admitted to the ward from the ED did not capture any immediately life-threatening arrhythmia. The observation of clinically relevant arrhythmia suggests that some relatively lower risk patients may benefit from CCM. Elucidation of this cohort can reduce the number of referrals for CCM and potentially improve patient flow within a hospital.