Is telemetry monitoring necessary in low-risk suspected acute chest pain syndromes?
BACKGROUND
Non-ICU telemetry monitoring has proven to be a valuable resource for patients suspected of having an acute myocardial infarction. While a significant number of patients are admitted to these units, the actual incidence of events or interventions is low.


OBJECTIVE
To identify a subset of patients in whom telemetry monitoring does not alter management.


METHODS
Prospective observational study.


METHODS
Large tertiary care facility.


METHODS
A total of 414 patients consecutively admitted from the emergency department for suspected acute coronary syndromes were studied. Patients were excluded if they presented with ST-segment elevations, were revascularized on hospital admission, were admitted to a surgical service, were transferred from another floor or unit, or remained in the emergency department for the course of the stay.


RESULTS
Events were defined as development of myocardial infarction, episodes of chest pain, new or rapid atrial arrhythmias, ventricular arrhythmias, any form of AV nodal block, and asystole. Intervention or change in management was any increase, decrease, or change in medication, cardioversion, electrophysiology study, or transfer to the ICU.


RESULTS
Patients who had atypical chest pain and normal ECG findings were significantly less likely to have both intervention and events (4 interventions vs 23 interventions [p < 0.0001], 12 events vs 45 events [p < 0.0001]), compared to those with typical chest pain and abnormal ECG findings. When normal laboratory values were added, only four telemetry events were observed.


CONCLUSIONS
Patients with atypical chest pain and normal ECG findings represent a subset of patients with low risk for life-threatening arrhythmia. Use of telemetry monitoring in this subset of patients should be reevaluated.
Snider
Adam
A
Center for Pulmonary and Critical Care Medicine, North Shore University Hospital, Manhasset, NY 11030, USA.
Papaleo
Marco
M
Beldner
Stuart
S
Park
Chong
C
Katechis
Dennis
D
Galinkin
David
D
Fein
Alan
A
D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013686:Telemetry / Q000706:statistics & numerical data