Does in-patient ECG monitoring have an impact on medical care in chronic heart failure patients?
BACKGROUND
Heart failure patients' management in non-intensive care units might be improved by telemetry monitoring. However, telemetry adds the cost and evidence of this effectiveness is not available.


OBJECTIVE
To evaluate the utility of the ECG monitoring in chronic heart failure patients admitted to a non-intensive care unit.


METHODS
A prospective analysis of the utility of telemetry in 711 patients admitted to a Heart Failure Unit from March 1996 to September 1997.


RESULTS
One hundred and ninety-nine patients underwent telemetry; 108 telemetry findings were recorded, in 35% of NYHA class II, in 46% in NYHA class III-IV and 43% in unstable patients. Reasons for telemetry were: known arrhythmia (n=82), electrolytes disturbances (n=20), atrial fibrillation (n=12), symptoms (n=48), i.v. dobutamine (n=13), drugs control (n=16), devices control (n=8). Crossing reasons for telemetry and detected events we had, respectively, 63, 11, 2, 17, 5, 6, and 0 telemetry findings. Treatment was guided by telemetry results in only 33 cases (respectively in 18, 0, 4, 5, 5, 1, and 0 cases). Physicians perceived telemetry as unhelpful in 30% of cases; as helpful in 70%. The percentage of inutility, usefulness with and without related medical intervention were similar between stable and unstable patients (30, 18, 51% and 31, 15, 54%, respectively).


CONCLUSIONS
In a heart failure unit ECG monitoring is mostly used in severe and unstable patients. However, medical decisions are rarely guided by the telemetry findings. The usefulness of telemetry might be underestimated because one of the uncounted results might be the avoidance of inappropriate intervention.
S. Maugeri Foundation, Institute of Care and Scientific Research, Department of Cardiology, Pavia, Italy. copasich@fsm.it
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Opasich
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Capomolla
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Riccardi
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Febo
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Forni
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Cobelli
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Tavazzi
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002300:Cardiac Care Facilities / Q000379:methods*; D002304:Cardiac Pacing, Artificial; D002908:Chronic Disease; D003657:Decision Making; D004554:Electric Countershock; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013686:Telemetry / Q000706:statistics & numerical data
D000889:Anti-Arrhythmia Agents