Slow Down: New-Onset Atrial Fibrillation Challenges for Ambulatory Surgical Facilities

As patient safety liaisons (PSLs), we are continually educating and collaborating with our Pennsylvania healthcare facilities. We often are asked questions about reportable events under the Medical Care Availability and Reduction of Error (MCARE) Act. One of the most common examples we discuss is cancellations and transfers out of an ambulatory surgical facility (ASF). The top three reasons for cancellations include preop instructions not followed, missed medical issues identified during preop screening, and no shows. The top three reasons for transfers include cardiac arrhythmias, aspiration, and hypertension. Interestingly, between discussions with facilities and review of event reports, new-onset atrial fibrillation (AF) has come up often as a common reason for cancellations or transfers out of the ASF setting, especially in gastrointestinal (GI) procedures. In fact, as PSLs, when educating ASFs on reportable events we often give the example of placing a patient on the cardiac monitor in preop and the patient is found to be in AF. In 2009, it was estimated that 13.1% of AF cases were undiagnosed,3 which may explain why patients are presenting with new-onset AF. People with AF are at an increased risk of complications (e.g., stroke);3,4 therefore, a cancellation or transfer may be necessary depending on the patient’s condition. These events are considered reportable to the Pennsylvania Patient Safety Reporting System (PA-PSRS) under MCARE.

Arrhythmia patterns in patients with COVID-19 infection during and post hospitalization detected via a patch-based mobile cardiac telemetry system

Background Coronavirus infection (COVID-19) is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. In response to COVID-19 pandemic and overwhelmed hospital critical care and telemetry recourses, patch-based cardiac monitoring system received emergency Food and Drug Administration (FDA) approval for inpatient monitoring. A patch-based cardiac telemetry system has been shown to be useful for patient management during the COVID-19 pandemic and provides detailed analysis of cardiac rhythms. Purpose To analyze arrhythmia type and frequency in patients with COVID-19 infection, identifying arrhythmia patterns over time during hospitalization and after discharge. Methods A prospective cohort study during the COVID-19 pandemic was performed. We included patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. A quantitative analysis including type, frequency and duration of detected arrhythmias was performed at the end of the monitoring period. Results A total of 103 patients hospitalized with COVID-19 diagnosis underwent monitoring. Quantitative reports for 59 patients were available for analysis, among those 59% were males, median age 65 (IQR 56–76) yrs. Mean wear time was 6.8±5.0 days. Arrhythmias were detected in 72.9% of patients. Majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). Episodes of AF duration >30 min were detected in 12 patients. New onset AF was noted in 15.0% of patients and was significantly associated with age (OR 1.4 for 5 yrs difference; 95% CI 1.01–2.05). Brady arrhythmias (2nd degree, 3rd degree AV bock, pause≥3 seconds) were seen in 18.7% of patients. Arrhythmias were consistently detected throughout the monitoring period in 52.9%-89.5% of patients daily (Figure 1). In 9 patients who were discharged with continued patch monitoring, 3 patients (33.3%) had arrhythmic events during their outpatient monitoring period. Conclusion A majority of patients hospitalized with COVID-19 infection had arrhythmias detected by patch cardiac monitor. Arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type similar to that seen during hospitalization. New onset AF often occurred and was associated with older age. Inpatient application of a patch cardiac telemetry with continued monitoring as outpatient is feasible and effective in detecting occult arrhythmias in patients with COVID-19 infection. FUNDunding Acknowledgement Type of funding sources: None. Daily frequency of arrhythmias detected