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
ARTICLE HIGHLIGHTS
Research background
Non-intensive-care inpatient telemetry monitoring is a widely used observation tool in cardiovascular medicine.
Research motivation
Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.
Research objectives
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.
Research methods
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.
Research results
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).
Research conclusions
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.
Research perspectives
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.
