Background Cardiac monitoring (telemetry) is a common over-utilized hospital resource in the United States. Previous studies have shown that telemetry does not improve outcomes for low-risk patients. Inappropriate utilization occurs because of lack of awareness of guideline-based indications or non-adherence to known indications. Objective A quality improvement study was conducted to reduce telemetry overutilization during the transition of care from the intensive care unit (ICU) by 15% through increasing awareness of indications for telemetry. Methods The study cohort included patients originally admitted to the ICU for sepsis who had improved and were stable for transfer to a non-ICU setting. Subjects were identified and included during pre-intervention (six weeks) and intervention (six weeks) periods. Resident physicians and nurse practitioners were targeted using multiple modalities of education: didactic lectures during week one, poster demonstrations during week three, and video presentations during week five. Results A total of 246 study subjects during the pre-intervention and 94 study subjects in the intervention period were studied; 187 of the 246 subjects in the pre-intervention arm (76%) and 58 of the 94 subjects in the intervention arm (61.7%) were transferred with telemetry. Telemetry utilization dropped by 23.1% at the end of the intervention period. Conclusion Educating the caregivers about the indications for telemetry led to a decrease in over-utilization of telemetry on the transition of care from the ICU to the regular nursing floor. Repetitive and multi-modality educational interventions were effective tools and associated with increased adherence to established guidelines for telemetry usage.

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Background: Cardiogenic shock (CS) is a heterogeneous clinical entity associated with poor outcomes. Patients with CS primarily due to an acute valvular dysfunction (valvular cardiogenic shock; VCS) constitute a unique cohort who remain poorly defined. We sought to define the prevalence and underlying patient characteristics of patients with VCS. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of CS were retrospectively identified through electronic medical records and confirmed via physician directed chart review. Patients with CS were subsequently categorized into those with VCS and non-VCS depending on the primary etiology responsible for CS. Characteristics of patients with VCS were analyzed to descriptively define this entity. Patients with mixed shock and those with incomplete variables were excluded. Results: Overall, 2754 patients were admitted to our CICU with CS of which 511 (18.6%) were determined to have VCS. The median age of patients with VCS was higher than those with non-VCS (70 yrs vs 64yrs, P<0.001). Patients with VCS were also more likely to be females (40.5% vs 31.8%, P<0.001), have higher prevalence of atrial fibrillation (56.9% vs 48.5%, p=0.001), chronic obstructive pulmonary disease (26.4% vs 20%, p=0.002), and prior history of valve replacement or repair (29.7% vs 7.9%, p<0.001) (Table 1). Patients with VCS were also significantly less likely to have prior MI (19.4% vs 46.6%, p<0.001). The aortic valve was most commonly implicated; with more native valve dysfunction as compared to prosthetic valve dysfunction (73% vs 27%, p<0.001). (Figure 1). Conclusion: One in 5 patients admitted with CS has VCS with native valves and the aortic position being the common culprit. The availability and impact of emergent percutaneous structural-interventions on clinical outcomes in this population warrants investigation.

Background: No prior studies have compared the outcomes of patients with valvular cardiogenic shock (VCS) depending on the treatment received. Our study aimed to assess this. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records and confirmed via physician directed chart review. Patients with CS were subsequently categorized into those with valvular cardiogenic shock (VCS) and non-valvular CS depending on the primary etiology responsible for hemodynamic instability. The impact of treatment strategy on 1-year all-cause mortality in patients with VCS was assessed with Kaplan-Meier (KM) estimates. Results: Overall 511 patients were admitted to our CICU with VCS during the study period. Out of these patients, 188 patients (37%) underwent surgery, 76 patients (15%) underwent percutaneous structural intervention, and 247 patients (48) % underwent conservative management. Comparison of baseline characteristics (Table 1) revealed that patients with VCS who underwent surgical treatment were significantly younger (median age 64 yrs vs 72 and 76 yrs, p<0.001), and less likely to have coexisting comorbidities such as diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). KM survival analysis revealed that VCS patients who underwent conservative management had the highest all-cause mortality at 1 year, whereas those patients who underwent surgery had the lowest all-cause mortality at 1 year (p<0.001) (Figure 1). Conclusion: Patients with VCS remain a high-risk cohort who are most likely to be conservatively managed. Of the patients who received a specific therapy, surgical management was associated with the best outcomes. The impact of early intervention in patients with VCS needs to be further explored.