Ventricular tachycardia and in-hospital mortality in the intensive care unit

Priya A Prasad; Jonas L Isaksen; Yumiko Abe-Jones; Jessica K Zègre-Hemsey; Claire E Sommargren; Salah S Al-Zaiti; Mary G Carey; Fabio Badilini; David Mortara; Jørgen K Kanters; Michele M Pelter

doi:10.1016/j.hroo.2023.09.008

Ventricular tachycardia and in-hospital mortality in the intensive care unit

Heart Rhythm O2. 2023 Sep 28;4(11):715-722. doi: 10.1016/j.hroo.2023.09.008. eCollection 2023 Nov.

Authors

Priya A Prasad^{1

2}, Jonas L Isaksen³, Yumiko Abe-Jones¹, Jessica K Zègre-Hemsey⁴, Claire E Sommargren⁵, Salah S Al-Zaiti⁶, Mary G Carey⁷, Fabio Badilini^{2

5

8}, David Mortara^{2

5

8}, Jørgen K Kanters³, Michele M Pelter^{2

5}

Affiliations

¹ Department of Medicine, Division of Hospital Medicine, School of Medicine, University of California, San Francisco, San Francisco, California.
² Center for Physiologic Research, University of California San Francisco School of Nursing, San Francisco, California.
³ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁵ Department of Physiological Nursing, University of California School of Nursing, San Francisco, California.
⁶ Department of Acute & Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁷ School of Nursing, University of Rochester, Rochester, New York.
⁸ Department of Medicine, Division of Cardiology, School of Medicine, University of California, San Francisco, San Francisco, California.

Abstract

Background: Continuous electrocardiographic (ECG) monitoring is used to identify ventricular tachycardia (VT), but false alarms occur frequently.

Objective: The purpose of this study was to assess the rate of 30-day in-hospital mortality associated with VT alerts generated from bedside ECG monitors to those from a new algorithm among intensive care unit (ICU) patients.

Methods: We conducted a retrospective cohort study in consecutive adult ICU patients at an urban academic medical center and compared current bedside monitor VT alerts, VT alerts from a new-unannotated algorithm, and true-annotated VT. We used survival analysis to explore the association between VT alerts and mortality.

Results: We included 5679 ICU admissions (mean age 58 ± 17 years; 48% women), 503 (8.9%) experienced 30-day in-hospital mortality. A total of 30.1% had at least 1 current bedside monitor VT alert, 14.3% had a new-unannotated algorithm VT alert, and 11.6% had true-annotated VT. Bedside monitor VT alert was not associated with increased rate of 30-day mortality (adjusted hazard ratio [aHR] 1.06; 95% confidence interval [CI] 0.88-1.27), but there was an association for VT alerts from our new-unannotated algorithm (aHR 1.38; 95% CI 1.12-1.69) and true-annotated VT(aHR 1.39; 95% CI 1.12-1.73).

Conclusion: Unannotated and annotated-true VT were associated with increased rate of 30-day in-hospital mortality, whereas current bedside monitor VT was not. Our new algorithm may accurately identify high-risk VT; however, prospective validation is needed.

Keywords: Alarm fatigue; Algorithm development; Continuous electrocardiographic monitoring; In-hospital mortality; Intensive care unit; Ventricular tachycardia.