Published online Feb 26, 2023. doi: 10.4330/wjc.v15.i2.56
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
Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.
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.
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.
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).
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.