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Most patients who present to emergency departments with chest pain undergo cardiac monitoring during their ED evaluation so that sudden dangerous arrhythmias can be identified and treated rapidly. The incidence of serious arrhythmia in hospitalized patients on telemetry is very low (<1%), but the incidence in ED patients is not known.
Researchers sought to develop a decision rule that would identify patients who can be taken off monitoring. They retrospectively analyzed data from a prospective study of 992 consecutive patients who presented to a single ED with chest pain and underwent cardiac monitoring. At presentation, 12% of patients had arrhythmia (most often atrial fibrillation or a paced rhythm) and 60% had active chest pain. On initia…