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

Priya A. Prasad*, Jonas L. Isaksen, Yumiko Abe-Jones, Jessica K. Zègre-Hemsey, Claire E. Sommargren, Salah S. Al-Zaiti, Mary G. Carey, Fabio Badilini, David Mortara, Jørgen K. Kanters, Michele M. Pelter

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
JournalHeart Rhythm O2
Volume4
Issue number11
Pages (from-to)715-722
ISSN2666-5018
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 Heart Rhythm Society

Keywords

  • Alarm fatigue
  • Algorithm development
  • Continuous electrocardiographic monitoring
  • In-hospital mortality
  • Intensive care unit
  • Ventricular tachycardia

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