Utility of short-term telemetry heart rhythm monitoring and CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-VASc score should be performed to validate the CHA(2)DS(2)-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.