Validating and implementing cardiac telemetry for continuous QTc monitoring: A novel approach to increase healthcare personnel safety during the COVID-19 pandemic.
Identifieur interne : 000040 ( Main/Exploration ); précédent : 000039; suivant : 000041Validating and implementing cardiac telemetry for continuous QTc monitoring: A novel approach to increase healthcare personnel safety during the COVID-19 pandemic.
Auteurs : Nicholas Kassis [États-Unis] ; Christine Tanaka-Esposito [États-Unis] ; Roy Chung [États-Unis] ; Ankur Kalra [États-Unis] ; Mingyuan Shao [États-Unis] ; Ashish Kumar [Inde] ; Jafar Alzubi [États-Unis] ; Mina K. Chung [États-Unis] ; Umesh N. Khot [États-Unis]Source :
- Journal of electrocardiology [ 1532-8430 ] ; 2021.
Abstract
BACKGROUND
Minimizing direct patient contact among healthcare personnel is crucial for mitigating infectious risk during the coronavirus disease 2019 (COVID-19) pandemic. The use of remote cardiac telemetry as an alternative to 12‑lead electrocardiography (ECG) for continuous QTc monitoring may facilitate this strategy, but its application has not yet been validated or implemented.
METHODS
In the validation component of this two-part prospective cohort study, a total of 65 hospitalized patients with simultaneous ECG and telemetry were identified. QTc obtained via remote telemetry as measured by 3 independent, blinded operators were compared with ECG as assessed by 2 board-certified electrophysiologists as the gold-standard. Pearson correlation coefficients were calculated to measure the strength of linear correlation between the two methods. In a separate cohort comprised of 68 COVID-19 patients treated with combined hydroxychloroquine and azithromycin, telemetry-based QTc values were compared at serial time points after medication administration using Friedman rank-sum test of repeated measures.
RESULTS
Telemetry-based QTc measurements highly correlated with QTc values derived from ECG, with correlation coefficients of 0.74, 0.79, 0.85 (individual operators), and 0.84 (mean of all operators). Among the COVID-19 cohort, treatment led to a median QTc increase of 15 milliseconds between baseline and following the 9th dose (p = 0.002), with 8 (12%) patients exhibiting an increase in QTc ≥ 60 milliseconds and 4 (6%) developing QTc ≥ 500 milliseconds.
CONCLUSIONS
Cardiac telemetry is a validated clinical tool for QTc monitoring that may serve an expanding role during the COVID-19 pandemic strengthened by its remote and continuous monitoring capability and ubiquitous presence throughout hospitals.
DOI: 10.1016/j.jelectrocard.2021.04.014
PubMed: 33975077
PubMed Central: PMC8076730
Affiliations:
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xml:lang="en">Validating and implementing cardiac telemetry for continuous QTc monitoring: A novel approach to increase healthcare personnel safety during the COVID-19 pandemic.</title><author><name sortKey="Kassis, Nicholas" sort="Kassis, Nicholas" uniqKey="Kassis N" first="Nicholas" last="Kassis">Nicholas Kassis</name><affiliation wicri:level="2"><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Tanaka Esposito, Christine" sort="Tanaka Esposito, Christine" uniqKey="Tanaka Esposito C" first="Christine" last="Tanaka-Esposito">Christine Tanaka-Esposito</name><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Chung, Roy" sort="Chung, Roy" uniqKey="Chung R" first="Roy" last="Chung">Roy Chung</name><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Kalra, Ankur" sort="Kalra, Ankur" uniqKey="Kalra A" first="Ankur" last="Kalra">Ankur Kalra</name><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Shao, Mingyuan" sort="Shao, Mingyuan" uniqKey="Shao M" first="Mingyuan" last="Shao">Mingyuan Shao</name><affiliation wicri:level="2"><nlm:affiliation>Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Kumar, Ashish" sort="Kumar, Ashish" uniqKey="Kumar A" first="Ashish" last="Kumar">Ashish Kumar</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care, St. John's Medical College Hospital, Bangalore, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Critical Care, St. John's Medical College Hospital, Bangalore</wicri:regionArea><wicri:noRegion>Bangalore</wicri:noRegion></affiliation></author><author><name sortKey="Alzubi, Jafar" sort="Alzubi, Jafar" uniqKey="Alzubi J" first="Jafar" last="Alzubi">Jafar Alzubi</name><affiliation wicri:level="2"><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Chung, Mina K" sort="Chung, Mina K" uniqKey="Chung M" first="Mina K" last="Chung">Mina K. Chung</name><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Khot, Umesh N" sort="Khot, Umesh N" uniqKey="Khot U" first="Umesh N" last="Khot">Umesh N. Khot</name><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: khotu@ccf.org.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j">Journal of electrocardiology</title><idno type="eISSN">1532-8430</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Minimizing direct patient contact among healthcare personnel is crucial for mitigating infectious risk during the coronavirus disease 2019 (COVID-19) pandemic. The use of remote cardiac telemetry as an alternative to 12‑lead electrocardiography (ECG) for continuous QTc monitoring may facilitate this strategy, but its application has not yet been validated or implemented.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>In the validation component of this two-part prospective cohort study, a total of 65 hospitalized patients with simultaneous ECG and telemetry were identified. QTc obtained via remote telemetry as measured by 3 independent, blinded operators were compared with ECG as assessed by 2 board-certified electrophysiologists as the gold-standard. Pearson correlation coefficients were calculated to measure the strength of linear correlation between the two methods. In a separate cohort comprised of 68 COVID-19 patients treated with combined hydroxychloroquine and azithromycin, telemetry-based QTc values were compared at serial time points after medication administration using Friedman rank-sum test of repeated measures.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Telemetry-based QTc measurements highly correlated with QTc values derived from ECG, with correlation coefficients of 0.74, 0.79, 0.85 (individual operators), and 0.84 (mean of all operators). Among the COVID-19 cohort, treatment led to a median QTc increase of 15 milliseconds between baseline and following the 9th dose (p = 0.002), with 8 (12%) patients exhibiting an increase in QTc ≥ 60 milliseconds and 4 (6%) developing QTc ≥ 500 milliseconds.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Cardiac telemetry is a validated clinical tool for QTc monitoring that may serve an expanding role during the COVID-19 pandemic strengthened by its remote and continuous monitoring capability and ubiquitous presence throughout hospitals.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33975077</PMID><DateRevised><Year>2021</Year><Month>05</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1532-8430</ISSN><JournalIssue CitedMedium="Internet"><Volume>67</Volume><PubDate><Year>2021</Year><Month>Apr</Month><Day>27</Day></PubDate></JournalIssue><Title>Journal of electrocardiology</Title><ISOAbbreviation>J Electrocardiol</ISOAbbreviation></Journal><ArticleTitle>Validating and implementing cardiac telemetry for continuous QTc monitoring: A novel approach to increase healthcare personnel safety during the COVID-19 pandemic.</ArticleTitle><Pagination><MedlinePgn>1-6</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0022-0736(21)00086-8</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jelectrocard.2021.04.014</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Minimizing direct patient contact among healthcare personnel is crucial for mitigating infectious risk during the coronavirus disease 2019 (COVID-19) pandemic. The use of remote cardiac telemetry as an alternative to 12‑lead electrocardiography (ECG) for continuous QTc monitoring may facilitate this strategy, but its application has not yet been validated or implemented.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">In the validation component of this two-part prospective cohort study, a total of 65 hospitalized patients with simultaneous ECG and telemetry were identified. QTc obtained via remote telemetry as measured by 3 independent, blinded operators were compared with ECG as assessed by 2 board-certified electrophysiologists as the gold-standard. Pearson correlation coefficients were calculated to measure the strength of linear correlation between the two methods. In a separate cohort comprised of 68 COVID-19 patients treated with combined hydroxychloroquine and azithromycin, telemetry-based QTc values were compared at serial time points after medication administration using Friedman rank-sum test of repeated measures.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Telemetry-based QTc measurements highly correlated with QTc values derived from ECG, with correlation coefficients of 0.74, 0.79, 0.85 (individual operators), and 0.84 (mean of all operators). Among the COVID-19 cohort, treatment led to a median QTc increase of 15 milliseconds between baseline and following the 9th dose (p = 0.002), with 8 (12%) patients exhibiting an increase in QTc ≥ 60 milliseconds and 4 (6%) developing QTc ≥ 500 milliseconds.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Cardiac telemetry is a validated clinical tool for QTc monitoring that may serve an expanding role during the COVID-19 pandemic strengthened by its remote and continuous monitoring capability and ubiquitous presence throughout hospitals.</AbstractText><CopyrightInformation>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kassis</LastName><ForeName>Nicholas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tanaka-Esposito</LastName><ForeName>Christine</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chung</LastName><ForeName>Roy</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kalra</LastName><ForeName>Ankur</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shao</LastName><ForeName>Mingyuan</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kumar</LastName><ForeName>Ashish</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Critical Care, St. John's Medical College Hospital, Bangalore, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alzubi</LastName><ForeName>Jafar</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chung</LastName><ForeName>Mina K</ForeName><Initials>MK</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khot</LastName><ForeName>Umesh N</ForeName><Initials>UN</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: khotu@ccf.org.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>04</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Electrocardiol</MedlineTA><NlmUniqueID>0153605</NlmUniqueID><ISSNLinking>0022-0736</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Cardiac telemetry</Keyword><Keyword MajorTopicYN="N">Coronavirus 2019</Keyword><Keyword MajorTopicYN="N">QT interval</Keyword><Keyword MajorTopicYN="N">QTc</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>01</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>04</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>04</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>5</Month><Day>11</Day><Hour>20</Hour><Minute>15</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33975077</ArticleId><ArticleId IdType="pii">S0022-0736(21)00086-8</ArticleId><ArticleId IdType="doi">10.1016/j.jelectrocard.2021.04.014</ArticleId><ArticleId IdType="pmc">PMC8076730</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Inde</li><li>États-Unis</li></country><region><li>Ohio</li></region></list><tree><country name="États-Unis"><region name="Ohio"><name sortKey="Kassis, Nicholas" sort="Kassis, Nicholas" uniqKey="Kassis N" first="Nicholas" last="Kassis">Nicholas Kassis</name></region><name sortKey="Alzubi, Jafar" sort="Alzubi, Jafar" uniqKey="Alzubi J" first="Jafar" last="Alzubi">Jafar Alzubi</name><name sortKey="Chung, Mina K" sort="Chung, Mina K" uniqKey="Chung M" first="Mina K" last="Chung">Mina K. Chung</name><name sortKey="Chung, Roy" sort="Chung, Roy" uniqKey="Chung R" first="Roy" last="Chung">Roy Chung</name><name sortKey="Kalra, Ankur" sort="Kalra, Ankur" uniqKey="Kalra A" first="Ankur" last="Kalra">Ankur Kalra</name><name sortKey="Khot, Umesh N" sort="Khot, Umesh N" uniqKey="Khot U" first="Umesh N" last="Khot">Umesh N. Khot</name><name sortKey="Shao, Mingyuan" sort="Shao, Mingyuan" uniqKey="Shao M" first="Mingyuan" last="Shao">Mingyuan Shao</name><name sortKey="Tanaka Esposito, Christine" sort="Tanaka Esposito, Christine" uniqKey="Tanaka Esposito C" first="Christine" last="Tanaka-Esposito">Christine Tanaka-Esposito</name></country><country name="Inde"><noRegion><name sortKey="Kumar, Ashish" sort="Kumar, Ashish" uniqKey="Kumar A" first="Ashish" last="Kumar">Ashish Kumar</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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