Remote Cardiac Rhythm Monitoring – Establishing Remote Cardiac Monitoring Criteria for Embolic Stroke Unknown Source (ESUS) Patients at Auckland City Hospital

Abstract

Background: Remote Cardiac Rhythm Monitoring (CRM) is a service that has been provided to the wards at Auckland City Hospital by the Coronary Care Unit (CCU) since 2001. Since 2010 demand for this service has increased by an average of 12% each year. The Stroke unit was established in ward 63 in December 2009 and referred all patients presenting with stroke for CRM monitoring. The criteria for requesting CRM was not clearly established. From 2010 to 2016 Ward 63 has been the highest single user of remote cardiac monitoring, averaging 17% of the total patient numbers. In 2016 a review of the patient data was undertaken in an attempt to rationalize the use of the CRM service. Method: CCU has maintained a database of the CRM service since 2002. The 2015 data from ward 63 was analysed and patient's identified to have had a stroke and Atrial Fibrillation (AF) were broken down into groups; known AF, AF on commencement of monitoring and patients who developed AF while on monitoring. Results: Of 338 patients monitored from ward 63 with a stroke, 38 patients were noted to have AF. Of this group 22 were known to have AF, 31 were in AF on commencement of monitoring and 16 had a new detection of AF whilst on CRM. This data was presented to the Stroke service and it was established that patients who had AF on presentation did not require CRM monitoring. In collaboration with the Stroke service specific cardiac monitoring criteria was developed for ESUS patients. Patients requiring greater than 24hrs monitoring are referred for inpatient holter monitoring rather than CRM. Conclusion: Review of the CRM data and establishment of stroke specific cardiac monitoring criteria has enabled us to potentially reduce the number of stroke patients using the CRM service by 10%.