TY - JOUR

T1 - Ventricular tachycardia and in-hospital mortality in the intensive care unit

AU - Prasad, Priya A.

AU - Isaksen, Jonas L.

AU - Abe-Jones, Yumiko

AU - Zègre-Hemsey, Jessica K.

AU - Sommargren, Claire E.

AU - Al-Zaiti, Salah S.

AU - Carey, Mary G.

AU - Badilini, Fabio

AU - Mortara, David

AU - Kanters, Jørgen K.

AU - Pelter, Michele M.

N1 - Publisher Copyright: © 2023 Heart Rhythm Society

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - Alarm fatigue

KW - Algorithm development

KW - Continuous electrocardiographic monitoring

KW - In-hospital mortality

KW - Intensive care unit

KW - Ventricular tachycardia

U2 - 10.1016/j.hroo.2023.09.008

DO - 10.1016/j.hroo.2023.09.008

M3 - Journal article

C2 - 38034889

AN - SCOPUS:85175268093

VL - 4

SP - 715

EP - 722

JO - Heart Rhythm O2

JF - Heart Rhythm O2

SN - 2666-5018

IS - 11

ER -