title: Does cardiac rhythm monitoring in patients with elevated troponin levels lead to changes in management?
abstract: BACKGROUND
  We sought to identify the frequency of arrhythmias in patients with elevated cardiac troponin levels and without ST-segment elevation myocardial infarction or a primary arrhythmia, and to determine whether detection of an arrhythmia leads to management changes.
  
  
  METHODS
  A review of 1381 consecutive patients admitted from the emergency department for rhythm monitoring with an elevated cardiac troponin T (cTnT) level was performed. Patients admitted to an intensive care unit and those with an initial primary arrhythmia were excluded. Troponin values were obtained on admission, at 3 hours and at 6 hours. Electronic medical records and all rhythm recordings were reviewed for documentation of an arrhythmia and any changes in management.
  
  
  RESULTS
  An arrhythmia was detected in 26% of the 330 patients who met the inclusion criteria. Those with arrhythmias had higher rates of coronary artery disease and prior percutaneous coronary intervention ( p = 0.02 and p = 0.01, respectively). Those with arrhythmias had higher mean cTnT values compared to those without arrhythmias ( p = 0.02 at 3 hours and p = 0.006 at 6 hours) even after controlling for a discharge diagnosis of acute coronary syndrome. Changes in management in response to the detection of arrhythmias were infrequent (6.3%) and usually included only changes in medication doses.
  
  
  CONCLUSIONS
  Patients admitted with an elevated cTnT level to a non-intensive care unit rhythm-monitored bed without ST-segment elevation myocardial infarction or primary arrhythmia have a high incidence of arrhythmias; however, changes in management are infrequent.
authors.affiliation: 1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Korosh
authors.initials: K
authors.lastname: Sharain
authors.affiliation: 1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Vlad C
authors.initials: VC
authors.lastname: Vasile
authors.affiliation: 2 Division of Cardiology, Department of Medicine and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D019468:Disease Management; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008991:Monitoring, Physiologic / Q000379:methods*; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction; D013686:Telemetry / Q000379:methods*; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: Acute coronary syndrome; arrhythmia; rhythm monitoring; telemetry; troponin