From the Guidelines
Patients who should be kept on telemetry during hospitalization include those with acute coronary syndromes, significant arrhythmias, acute heart failure, post-cardiac surgery patients, and those at high risk for sudden cardiac death, as recommended by the most recent guidelines 1. The decision to keep a patient on telemetry is based on their individual risk factors and medical conditions. Some specific indications for telemetry monitoring include:
- Acute coronary syndromes, such as ST-elevation or non-ST-elevation myocardial infarction, or unstable angina
- Significant arrhythmias, such as symptomatic bradycardia or tachycardia, new-onset atrial fibrillation with rapid ventricular response, ventricular tachycardia, or complete heart block
- Acute heart failure, particularly in patients with a history of heart failure or those who are hemodynamically unstable
- Post-cardiac surgery patients, especially those who have undergone procedures with a high risk of arrhythmias
- Patients at high risk for sudden cardiac death, such as those with a history of ventricular arrhythmias or those with implanted cardiac devices experiencing malfunction Additionally, patients with certain electrolyte abnormalities, such as potassium, magnesium, or calcium imbalances, or those undergoing procedures with a risk of arrhythmias, may also benefit from telemetry monitoring 1. The duration of telemetry monitoring should be individualized based on the patient's condition, with higher-risk patients requiring longer monitoring periods 1. It is also important to consider the diagnostic yield of telemetry monitoring in certain patient populations, such as those with syncope of suspected cardiac origin, and to use this information to guide decision-making about the use of telemetry 1.
From the FDA Drug Label
In both DIAMOND studies, all patients were hospitalized for at least 3 days after treatment was initiated and monitored by telemetry. Patients with QTc greater than 460 msec, second or third degree AV block (unless with pacemaker), resting heart rate <50 bpm, or prior history of polymorphic ventricular tachycardia were excluded The steps described above are summarized in the following diagram: Place Patient on Telemetry
Reasons to keep people on telemetry while inpatient:
- To monitor the QT interval after administration of the first dose of Sotalol AF or other antiarrhythmic medications
- For patients with a history of atrial fibrillation or atrial flutter, to monitor for recurrence of the arrhythmia
- For patients with impaired left ventricular function or recent myocardial infarction, to monitor for worsening heart failure or arrhythmic events
- To monitor for proarrhythmic events, such as Torsade de Pointes, which can occur with the use of antiarrhythmic medications
- For patients with renal impairment, to monitor for changes in creatinine clearance and adjust the dose of the medication accordingly
- To monitor for other adverse events, such as increased QT interval or QTc, second or third degree AV block, or resting heart rate <50 bpm 2
From the Research
Reasons for Telemetry Monitoring
The decision to keep patients on telemetry while inpatient is guided by specific criteria and guidelines. According to 3, the American Heart Association (AHA) developed Practice Standards for the appropriate use of telemetry monitoring, which were updated in 2017. These standards aim to ensure that telemetry is used judiciously and only when necessary.
Patient Selection for Telemetry
Studies have identified certain patient populations that benefit from cardiac rhythm monitoring. For example, patients with complex arrhythmias, myocardial ischemia, or those at risk of cardiac complications may require telemetry monitoring 4. The AHA guidelines provide a framework for selecting patients who would benefit from telemetry, including those with a history of cardiac disease, arrhythmias, or other high-risk conditions.
Benefits of Appropriate Telemetry Use
Appropriate use of telemetry can lead to improved patient outcomes, reduced healthcare costs, and increased efficiency in care delivery. A study published in 5 found that implementing AHA guidelines for telemetry use resulted in a significant reduction in patient days on telemetry, from 7.20 days to 3.51 days. This reduction in telemetry use was achieved without compromising patient care.
Monitoring for Cardiac Complications
Telemetry monitoring is also important for detecting cardiac complications, such as long QT syndrome, which can be caused by certain medications used to manage arrhythmias 6. Close monitoring of the QT interval is recommended for patients receiving anti-arrhythmic therapy, particularly those with risk factors for long QT syndrome.
Key Indications for Telemetry
Some key indications for telemetry monitoring include:
- Complex arrhythmias
- Myocardial ischemia
- High-risk cardiac conditions
- Patients receiving anti-arrhythmic therapy
- Those with a history of cardiac disease or arrhythmias
- Patients at risk of cardiac complications, such as long QT syndrome
By following established guidelines and selecting patients appropriately for telemetry monitoring, healthcare providers can ensure that this resource is used efficiently and effectively, ultimately improving patient outcomes and reducing healthcare costs 7.