Bhuiya T, Roman S, Aydin T, Patel B, Zeltser R, Makaryus AN. Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident. World J Cardiol 2023; 15(2): 56-63 [PMID: 36911749 DOI: 10.4330/wjc.v15.i2.56]
Corresponding Author of This Article
Amgad N Makaryus, MD, FACC, Professor, Chairman, Department of Cardiology, Nassau University Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States. amakaryu@numc.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2023; 15(2): 56-63 Published online Feb 26, 2023. doi: 10.4330/wjc.v15.i2.56
Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident
Tanzim Bhuiya, Sherif Roman, Taner Aydin, Bhakti Patel, Roman Zeltser, Amgad N Makaryus
Tanzim Bhuiya, Taner Aydin, Bhakti Patel, Roman Zeltser, Amgad N Makaryus, Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
Sherif Roman, Department of Cardiology, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
Roman Zeltser, Amgad N Makaryus, Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
Author contributions: Aydin T, Zeltser R, Makaryus AN performed the research; Bhuiya T and Zeltser R performed the statistical analyses in the paper; Zeltser R and Makaryus AN designed the research and contributed to the analysis; Bhuiya T, Roman S, Aydin T, Patel B, Makaryus AN, wrote the paper; Zeltser R, and Makaryus AN supervised the report.
Institutional review board statement: The study was reviewed and approved by our institutional review board (IRB) as an expedited study (IRB#16-093).
Informed consent statement: This research was a retrospective anonymized evaluation and informed consent was not required for IRB approval of this expedited study. The information was recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects. Our IRB approval document is provided separately.
Conflict-of-interest statement: Authors of no conflict of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at amakaryu@numc.edu.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amgad N Makaryus, MD, FACC, Professor, Chairman, Department of Cardiology, Nassau University Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States. amakaryu@numc.edu
Received: September 26, 2022 Peer-review started: September 26, 2022 First decision: December 19, 2022 Revised: January 10, 2023 Accepted: February 7, 2023 Article in press: February 7, 2023 Published online: February 26, 2023 Processing time: 147 Days and 10.3 Hours
Abstract
BACKGROUND
Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.
AIM
To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident (CVA) or transient ischemic attack (TIA) requires inpatient telemetry monitoring.
METHODS
A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively. We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.
RESULTS
In our study population, 63 (24.5%) of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event. Of the 194 (75.5) patients that had a confirmed CVA/TIA, only 6 (2.3%) had an arrhythmia detected during their inpatient telemetry monitoring period. Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event (3.59 vs 2.61, P < 0.001).
CONCLUSION
Given the low percentage of inpatient arrhythmias identified, further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA. A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.
Core Tip: Inpatient telemetry monitoring can be a costly resource in hospitals. Inappropriate use of this clinical tool only increases burgeoning healthcare costs both to the patient and the hospital. Atrial fibrillation is a risk factor for stroke which is why telemetry is indicated for 24-48 h after a cerebrovascular accident. However, telemetry for all patients for this short period of time can be non-diagnostic. Our study shows telemetry can be better utilized in patients with higher risk factors for atrial fibrillation as seen with higher CHA2DS2-VASc scores, and this stratification of telemetry monitoring may allow appropriate allocation and use for patients in whom benefit will be derived.
