National Survey of Cardiologists' Standard of Practice for Continuous ST-segment Monitoring

Am J Crit Care. 2010 Mar;19(2):112-23. doi: 10.4037/ajcc2010264.

Abstract

Background: Continuous ST-segment monitoring can be used to detect early and transient cardiac ischemia. The American Heart Association and American Association of Critical-Care Nurses recommend its use among specific patients, but such monitoring is routine practice in only about half of US hospitals.

Objective: To determine cardiologists' awareness and practice standards regarding continuous ST-segment monitoring and the physicians' perceptions of appropriate patient selection, benefits and barriers, and usefulness of this technology.

Methods: An electronic survey was sent to a random sample of 915 US cardiologists from a pool of 4985 certified cardiologists.

Results: Of 200 responding cardiologists, 55% were unaware of the consensus guidelines. Of hospitals where respondents admitted patients, 49% had a standard of practice for using continuous ST-segment monitoring for cardiac patients. Most cardiologists agreed or strongly agreed that patients in the cardiovascular laboratory (87.5%) and intensive care unit (80.5%) should have such monitoring. Cardiologists routinely ordered ST monitoring for patients with acute coronary syndrome (67%) and after percutaneous coronary intervention (60%). The primary factor associated with higher perceptions for benefits, clinical usefulness, and past use of continuous ST-segment monitoring was whether or not hospitals in which cardiologists practiced had a standard of practice for using this monitoring. A secondary factor was awareness of published consensus guidelines for such monitoring.

Conclusion: Respondents (55%) were unaware of published monitoring guidelines. Hospital leaders could raise awareness by multidisciplinary review of evidence and possibly incorporating continuous ST-segment monitoring into hospitals' standards of practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • American Heart Association
  • Cardiology / standards*
  • Coronary Care Units / standards
  • Early Diagnosis
  • Electrocardiography / standards*
  • Female
  • Guideline Adherence
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Long QT Syndrome / diagnosis
  • Male
  • Middle Aged
  • Monitoring, Physiologic / standards
  • Myocardial Ischemia / diagnosis*
  • Practice Guidelines as Topic
  • United States