Cardiac Monitoring Is Unnecessary for Most Patients with Chest Pain in the Emergency Department

Cardiac monitoring is designed to detect life-threatening arrhythmias, but also has a high rate of “false alarms,” which can lead to alert fatigue and negatively impact patient safety and satisfaction. These authors prospectively validated the Ottawa Chest Pain Cardiac Monitoring Rule, which recommends removing the cardiac monitor if a patient is currently pain-free and has normal or nonspecific electrocardiogram results. The same authors derived the rule.

Among 796 adult patients with chest pain who were assigned to cardiac monitoring at two tertiary emergency departments, only 15 (1.9%) had an arrhythmia requiring intervention within 8 hours of ED arrival (the primary outcome). All 15 of these patients had abnormal ECGs, and 5 had ongoing …