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

BACKGROUNDInpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs. AIMTo 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. METHODSA 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.RESULTSIn 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). CONCLUSIONGiven 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.