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 Traditional on-site heart monitoring can involve a lot of false
alarms that don’t always help detect cardiac arrests and other
serious events, said lead study author Dr. David Cantillon, a
researcher at the Cleveland Clinic in Ohio.
“Important warning signs are often missed among a large volume of
nuisance alarms,” Cantillon said by email. “This is referred to as
alarm fatigue, and this has been associated with serious adverse
outcomes, including patient deaths across the United States.”
As an alternative, Cantillon and colleagues examined outcomes for
more than 99,000 heart patients at the Cleveland Clinic and three
nearby regional hospitals who were monitored remotely.
None of the patients in the study were in critical condition or
receiving intensive care.
Technicians at the remote central unit monitored up to 48 patients
at a time and alerted hospital staff whenever alarms suggested
something might be amiss.
These remote technicians provided more than 410,000 notifications
over the 13-month study period, about half of which were related to
heart rhythm or blood pressure issues, researchers report in JAMA.
Emergency response teams (ERTs) were activated in about 3,200 cases,
including 980 instances when the heart rhythm or blood pressure
changes occurred no more than an hour earlier. Most of these
warnings – 79 percent – were accurate notifications of situations
when patients needed urgent help, the study found.
In addition, the remote technicians directly notified ERTs on the
worsening condition of 105 patients who needed immediate
intervention. This included advance warning of 27 cardiopulmonary
arrests – all but two resulting in a return of circulation.
The remote monitoring system was also associated with a reduction in
the total number of patients who needed monitoring at any given
time. This so-called weekly census dropped by almost 16 percent,
when compared with the prior 13-month period.
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Overall, remote monitoring didn’t appear to lead to more cardiac
arrests. There were 122 during the study period and 126 in the
previous 13 months.
Limitations of the study include its observational design, which
makes it impossible to determine if remote monitoring directly
causes specific outcomes, the authors note.
To prove a benefit, researchers would need to randomly assign some
patients to receive on-site monitoring and others to off-site
monitoring, noted Dr. Sumeet Chugh, director of the Heart Rhythm
Center at Cedars-Sinai, Los Angeles.
But the findings still suggest that patients might benefit when
dangerous events are identified and emergency response teams are
activated quickly, Chugh, who wasn’t involved in the study, said by
email.
“In most hospitals, a certain proportion of beds are equipped with
the capability to monitor the patient’s heart and breathing in real
time,” Chugh said. “The goal is to catch any warnings or
abnormalities early, so that critical events such as heart or lung
arrest can be either prevented, or managed rapidly.”
SOURCE: http://bit.ly/2aKISft JAMA, online August 2, 2016.
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