Utility of short-term telemetry heart rhythm monitoring and CHADS-VASc stratification in patients presenting with suspected cerebrovascular accident.

BACKGROUND

Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.

AIM

To evaluate if CHADS-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident (CVA) or transient ischemic attack (TIA) requires inpatient telemetry monitoring.

METHODS

A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively. We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHADS-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.

RESULTS

In our study population, 63 (24.5%) of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event. Of the 194 (75.5) patients that had a confirmed CVA/TIA, only 6 (2.3%) had an arrhythmia detected during their inpatient telemetry monitoring period. Individuals with a confirmed CVA/TIA had a statistically significant higher CHADS-VASc score compared to individuals without an ischemic event (3.59 2.61, < 0.001).

CONCLUSION

Given the low percentage of inpatient arrhythmias identified, further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA. A prospective study assessing event rate of CVA/TIA in patients with higher CHADS-VASc score should be performed to validate the CHADS-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.