key: cord-029885-vawqjfij
authors: Piccini, Jonathan P.; Smith, Anne Marie
title: EP News: Quality Improvement and Outcomes
date: 2020-07-30
journal: Heart Rhythm
DOI: 10.1016/j.hrthm.2020.07.027
sha: 
doc_id: 29885
cord_uid: vawqjfij

nan

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. In this issue of Heart Rhythm, we continue this quarterly feature highlighting developments and advances in quality improvement in the delivery of heart rhythm care. The current issue focuses on quality improvement surrounding the challenges created for heart rhythm care during the coronavirus disease 2019 (COVID-19) pandemic. (7) planning administrative restructuring. They described their "ramp-down" including a reduction in laboratory case volume in 80%-95% following implementation of a policy to perform procedures only in patients felt to have a likelihood of significant clinical deterioration within a short period of time (i.e. 48 hours to 1-2 weeks). The authors also share their pearls regarding specific patient management including the challenges encountered in the implementation of telehealth. They also describe the use of remote inpatient consultation and telemetry for QTc determinations in COVID positive patients, performing generator change within 1 month after the onset of elective replacement indicator (ERI), and prioritization of same day discharges whenever possible. Based upon their experience, the authors conclude and emphasize the need for proactive planning during a pandemic, including the importance of developing contingency plans before the COVID-19 pandemic reaches a hospital system. They also emphasize the importance of streamlining care and mobilization of resources necessary for transitioning to telemedicine in the midst of a pandemic.

Hydroxychloroquine and/or Azithromycin Chang et al (J Am Coll Cardiol 2020; 75:2992-7 . PMID: 32330546) 3 conducted a single-center study evaluating the safety and feasibility of utilizing mobile cardiac outpatient telemetry for heart rhythm and QT monitoring in 117 patients with COVID-19 who were receiving hydroxychloroquine with or without azithromycin and were hospitalized on non-telemetry floors. Monitoring was continued until discharge or until the hydroxychloroquine with or without azithromycin therapy was completed. The average age of the patients was 60 years, 41% were women, 5% had coronary artery disease, and less than 1% had heart failure. Over 295 patient days of follow-up, there were 28 urgent alerts in 18 patients, including 15 alerts for atrial fibrillation with rapid ventricular rates, 2 alerts for nonsustained ventricular tachycardia, and 5 alerts for a QTc >500 msec. Overall, 16 of the 28 urgent alerts resulted in changes in patient management. Hydroxychloroquine was stopped in one patient after the QTc increased from 460 to 565 msec. The authors conclude that while mobile cardiac outpatient telemetry has not been approved for QTc monitoring for patients with atrial fibrillation or flutter, QRS duration >160 msec, or T-wave <5% of the peak QRS amplitude, their single-center study suggests that innovative management of QTc monitoring is possible under the resource-constrained conditions of a pandemic.

Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide from a New York City Hospital Network

Guidance for Cardiac Electrophysiology During the COVID-19 Pandemic from the Heart Rhythm Society COVID-19 Task Force

Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology

Inpatient Use of Ambulatory Telemetry Monitors for COVID-19 Patients Treated With Hydroxychloroquine and/or Azithromycin