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
Non-intensive-care inpatient telemetry monitoring is a widely used observation tool in cardiovascular medicine.
Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.
Our study aimed 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 retrospective cohort study was performed at a tertiary-care safety-net community hospital between January 2014 and December 2016 with a total of 257 consecutive patients admitted with suspected CVA or TIA. Telemetry monitoring was performed for at least 24 h, consistent with current standards of care. CVA or TIA was confirmed via current diagnostic guidelines (including patient evaluation by the neurology consulting service and/or non-invasive brain imaging studies). The CHA2DS2-VASc score was calculated for each patient. Independent variable t-tests were performed using SPSS Statistics, version 16.0, when comparing patients with and without a final diagnosis of CVA or TIA.
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.