Does cardiac rhythm monitoring in patients with elevated troponin levels lead to changes in management?

Korosh Sharain, Vlad C. Vasile, Allan S Jaffe

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We sought to identify the frequency of arrhythmias in patients with elevated cardiac troponin levels and without ST-segment elevation myocardial infarction or a primary arrhythmia, and to determine whether detection of an arrhythmia leads to management changes.

METHODS: A review of 1381 consecutive patients admitted from the emergency department for rhythm monitoring with an elevated cardiac troponin T (cTnT) level was performed. Patients admitted to an intensive care unit and those with an initial primary arrhythmia were excluded. Troponin values were obtained on admission, at 3 hours and at 6 hours. Electronic medical records and all rhythm recordings were reviewed for documentation of an arrhythmia and any changes in management.

RESULTS: An arrhythmia was detected in 26% of the 330 patients who met the inclusion criteria. Those with arrhythmias had higher rates of coronary artery disease and prior percutaneous coronary intervention ( p = 0.02 and p = 0.01, respectively). Those with arrhythmias had higher mean cTnT values compared to those without arrhythmias ( p = 0.02 at 3 hours and p = 0.006 at 6 hours) even after controlling for a discharge diagnosis of acute coronary syndrome. Changes in management in response to the detection of arrhythmias were infrequent (6.3%) and usually included only changes in medication doses.

CONCLUSIONS: Patients admitted with an elevated cTnT level to a non-intensive care unit rhythm-monitored bed without ST-segment elevation myocardial infarction or primary arrhythmia have a high incidence of arrhythmias; however, changes in management are infrequent.

Original languageEnglish (US)
Pages (from-to)545-552
Number of pages8
JournalEuropean heart journal. Acute cardiovascular care
Volume6
Issue number6
DOIs
StatePublished - Sep 1 2017

Keywords

  • Acute coronary syndrome
  • arrhythmia
  • rhythm monitoring
  • telemetry
  • troponin

ASJC Scopus subject areas

  • Medicine(all)

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