Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident

Tanzim Bhuiya; Sherif Roman; Taner Aydin; Bhakti Patel; Roman Zeltser; Amgad N Makaryus

doi:10.4330/wjc.v15.i2.56

Utility of short-term telemetry heart rhythm monitoring and CHA₂DS₂-VASc stratification in patients presenting with suspected cerebrovascular accident

World J Cardiol. 2023 Feb 26;15(2):56-63. doi: 10.4330/wjc.v15.i2.56.

Authors

Tanzim Bhuiya¹, Sherif Roman², Taner Aydin¹, Bhakti Patel¹, Roman Zeltser^{1

3}, Amgad N Makaryus^{1

4}

Affiliations

¹ Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States.
² Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ 07503, United States.
³ Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States.
⁴ Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States. amakaryu@numc.edu.

Abstract

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

Aim: To evaluate if CHA₂DS₂-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 CHA₂DS₂-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 CHA₂DS₂-VASc score compared to individuals without an ischemic event (3.59 vs 2.61, P < 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 CHA₂DS₂-VASc score should be performed to validate the CHA₂DS₂-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.

Keywords: Arrhythmia; Atrial fibrillation; CHA2DS2-VASc score; Telemetry monitoring.