Utility of Telemetry Monitoring in the Inpatient Management of Congestive Heart Failure

Abstract

Background American Heart Association guidelines recommend telemetry monitoring for all patients admitted with acute heart failure (AHF), due to an increased incidence of arrhythmia. Hypothesis Telemetry monitoring is not required in all patients admitted with AHF and does not change management in the majority of patients in which it is used. Methods This retrospective chart review included patients admitted with AHF at three tertiary centers. Outcomes of interest included incidence and timing of symptomatic ventricular tachycardia, symptomatic bradycardia, and new atrial fibrillation (AF) on telemetry, incidence of mortality, and change in patient management. Results Of the 363 adult patients included, 192 were monitored on telemetry. Previously undiagnosed AF occurred in 6 patients, 3 had symptomatic ventricular tachycardia, 6 had symptomatic bradycardia, 1 had both new AF and symptomatic ventricular tachycardia, and there was 1 arrhythmic death in the monitored group. Telemetry changed management in 5 of these patients. 82% of clinically significant arrhythmias occurred within 48 hours of initiation of telemetry; only one case occurring outside of this time frame caused hypotension. Conclusions A blanket approach to telemetry use may not be the most appropriate clinical or cost effective strategy. Telemetry leads to a change in management in a small percentage of cases and its yield decreases substantially beyond 48 hours after admission aside from patients with a separate risk factor for VT such as low EF or prior ventricular arrhythmia. Telemetry is likely not beneficial for monitoring all patients presenting with AHF, however it may have a role in diagnosing new AF, identifying arrhythmia as a cause of AHF, or monitoring for early bradycardia-related drug effects. As health resource stewardship becomes a more prominent issue in the practice environment, clinical judgment must be used to tailor diagnostic tools to individual patient needs.