Abstract 13943: Comparison of the Frequency and Time to True Ventricular Tachycardia Among Patients in the Cardiac, Medical/Surgical and Neurologic Intensive Care Units

Abstract

Introduction: Continuous ECG monitoring is the non-invasive gold standard used to identify ventricular tachycardia (VT), yet 87% of current bedside monitor VTs could be false. Therefore, knowing the burden of true VT is essential to guide treatment to those at greatest risk of poor outcomes. Hypothesis: When stratifying by intensive care unit (ICU) (cardiac, medical/surgical, neurological), there will be differences in: 1) demographic and clinical characteristics of patients with true VT; and 2) frequency and time to first true VT. Methods: Retrospective cohort study of adults admitted to an academic medical center ICU, 9/13-4/15. Potential VTs among 5,679 consecutive ICU patients were manually annotated by clinicians as true/false. Patient-level data were extracted from the health record. We used Kaplan-Meier and Cox proportional hazards methods to calculate time to first true VT and 60-day VT rate by ICU type. Results: There were differences in all characteristics examined (p<0.0001)(Table) and frequency of true VT, stratified by ICU type (log-rank p<0.0001)(Figure). After adjustment for age, gender, and risk factors (Table), CICU patients had a 42% increased rate (HR 1.42, 95% CI 1.16-1.74) and NICU patients had a 28% decreased rate of VT (HR 0.72, 95% CI 0.59-0.89) compared to M/SICU patients. Conclusion: Patients in the CICU experienced true VT much earlier (1.5 days) after admission than patients in the M/SICU and NICU. In addition, CICU patients had a higher rate of true VT and associated VT risk factors as compared to M/SICU and NICU patients. As expected, known cardiac risk factors are associated with true VT, but may be hidden among false alarms during bedside monitoring.