Telemetry Bed Usage for Patients with Low Risk Chest Pain

Every year, more than 8 million Americans present to the emergency department (ED) with chest pain, making it the 2nd most common complaint in the ED [1]. Although <5% of low-risk chest pain patients are found to have an acute myocardial infarction (MI) [2], many are admitted to the hospital for further evaluation. Telemetry monitoring in patients with low-risk chest pain is highly utilized, despite the lack of quality data to support its use. In fact, it rarely detects clinically meaningful dysrhythmias, may lead to unnecessary tests and procedures, is expensive, andsignificantly increases ED boarding due to patients awaiting inpatient telemetry beds [3, 4].

Executive Summary
1) Insufficient data exist to support telemetry use in low-risk chest pain patients.
2) Patients who are at low risk for significant 30-day morbidity and mortality and are therefore unlikely to benefit from telemetry monitoring should have a normal first set of cardiac enzymes and a Goldman risk score of zero (normal/non-diagnostic ECG plus none of the following: hypotension, rales above the bases, or pain worse than baseline angina).

The 2004 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for inpatient telemetry monitoring provide recommendations on how to best screen for dysrhythmias, ischemia, and QT interval abnormalities in adults[5]. These guidelines are based almost exclusively on expert opinion due to the dearth of pertinent clinical trials. The vague and confusing nature of these guidelines is highlighted in the Class I recommendation to keep all “rule-out MI” patients on telemetry until 24 hours after they are pain free. However, “Chest Pain Syndromes” is a separate subject in the guidelines under Class II recommendations. This ambiguity has undoubtedly facilitated the common practice of admitting all chest pain patients to telemetry.

Read More

References and Literature Grading (PDF)