CARDIAC UTILIZATION GUIDELINES DURING PANDEMIC

PRIORITY A PRIORITY B PRIORITY C Patients require continuous cardiac monitoring or Patients would likely benefit from close cardiac monitoring Patients do not have good evidence supporting benefit for good patient outcomes from close cardiac monitoring

INDICATOR REASSESS INDICATOR INDICATOR Moderate-high risk NSTEMI & STEMI 24h Fast /SVT but hemodynamically stable After non-urgent PCI, no complications Post MI after revascularization 12h Asymptomatic sinus bradycardia with negative Low risk NSTEMI or unstable angina, otherwise chronotropic medications initiated hemodynamically stable Post MI after revascularization with 24h residual ischemic lesions Asymptomatic 2nd AV block Chronic atrial fibrillation After non-urgent PCI, with 24h or until Syncope of suspected cardiac origin Sinus tachycardia complications resolved Known pacemaker or ICD but admitted w/ issues Post open on track 24h Based on the American Heart Association (AHA) 2017 practice Non- (except for major thoracic surgery) Hemodynamically unstable VT / Problem standards for electrocardiographic unstable congenital arrhythmic resolved or monitoring in hospital settings, this Hemodialysis syndromes ICD guide provides a prioritization list for Moderate to severe hypo/hyperkalemia or monitoring of patients during a magnesemia without ECG changes Hemodynamically unstable SVT/atrial Per ACLS pandemic. All monitors should be fibrillation guidelines reassessed after 24 hours. New acute stroke with Holter (first 24 hours) Symptomatic sinus bradycardia/ 2nd or 3rd degree AV block DISCRETION OF ATTENDING Acute decompensated HF requiring To be re-evaluated every 12-24 hours critical care bed with arrhythmias INDICATOR

TELEMETRY & CONTINUOUS BEDSIDE MONITORING . Stress cardiomyopathy/viral myocarditis . After transcutaneous aortic valve replacement (TAVR) . Prolonged QT on ECG from drug overdose . Asymptomatic third degree AV block Moderate to severe hypo or hyperkalemia or magnesemia with ECG changes (in the acute phase till . Post open heart off track . ICD shocks requiring hospital admission ECG abnormalities resolve) . Newly diagnosed left main coronary artery lesion (until revascularization)

Acronyms: ECG = electrocardiogram, HF = heart failure, ICD = Implantable Defibrillator, MI = Myocardial infarction, NSTEMI = non-ST elevation myocardial infarction, STEMI = ST elevation myocardial infarction, SVT – supraventricular tachycardia, VT – ventricular tachycardia,