Life-threatening arrhythmias are rare when reducing cardiac telemetry

If hospitals and health systems reduce their use of cardiac telemetry in nonintensive care settings, they are unlikely to miss life-threatening arrhythmias, according to a single-center study. Life-threatening arrhythmias occurred in one of 2,645 patients.

Pranav Kansara, MD, MPH, MS, of Christiana Care Health System in Newark, Del., and colleagues published their findings online in JAMA Internal Medicine on June 15.

Christiana Care Health System changed its telemetry protocol in March 2013 and integrated American Heart Association guidelines into their electronic ordering system. The alteration led to a 43 percent decrease in telemetry initiation and no increase in mortality, cardiac arrest or activation of the rapid response team.

In this analysis, Kansara et al compared two periods: before the protocol change (Oct. 19, 2012 to Nov. 19, 2012) and after the protocol change (May 22, 2013 to June 19, 2013). The health system categorized telemetry alarms as emergency or nonemergency and kept a detailed account of all alarms.

They examined a total of 7,200 alarms from 2,645 patients. The one patient who had a potential life-threatening arrhythmia had a self-terminated ventricular tachycardia that lasted 32 seconds, according to the researchers.

Of the 78 emergency alarms, 29 were classified as clinically important, although Kansara et al said only 14 led to a change in clinical management within an hour. They added that the majority of alarms were for rapid atrial tachyarrhythmia.

“Medicolegal concerns may contribute to telemetry overuse,” they wrote. “We believe our system mitigates this risk as an evidence-based standard of care applied to clinical decision making through protocols… This finding should be reassuring to those considering the recommendation of the Choosing Wisely campaign to limit non-intensive care unit telemetry.”