Daniel M. Lindberg, MD reviewing Syed S et al. CMAJ 2017 Jan 30.

Arrhythmias were rare, especially in patients with normal or non-specific electrocardiogram results.

Cardiac monitoring is designed to detect life-threatening arrhythmias, but also has a high rate of “false alarms,” which can lead to alert fatigue and negatively impact patient safety and satisfaction. These authors prospectively validated the Ottawa Chest Pain Cardiac Monitoring Rule, which recommends removing the cardiac monitor if a patient is currently pain-free and has normal or nonspecific electrocardiogram results. The same authors derived the rule.

Among 796 adult patients with chest pain who were assigned to cardiac monitoring at two tertiary emergency departments, only 15 (1.9%) had an arrhythmia requiring intervention within 8 hours of ED arrival (the primary outcome). All 15 of these patients had abnormal ECGs, and 5 had ongoing pain. The rule was therefore 100% sensitive (95% confidence interval, 78%–100%). The arrhythmias detected included 12 cases of atrial fibrillation or flutter, 2 cases of supraventricular tachycardia, and 1 case of ventricular tachycardia (in a 68-year-old man with ongoing pain and a paced rhythm on ECG). Application of the rule would have permitted removing 286 patients (36%) from cardiac monitoring.

CITATION(S):

Syed S et al. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring. CMAJ 2017 Jan 30; 189:E139.

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