Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

We considered whether positive and stable self-stereotypes of stigmatized group members can influence functioning (in contrast, stereotype threat theory suggests these influential self-stereotypes are limited to ones that are negative and situational). Specifically, we examined older individuals' positive age stereotypes after a life-threatening event, an acute myocardial infarction (AMI). Sixty-two persons, aged 50 to 96, participated. As expected, positive age stereotypes were found, even immediately after an AMI, and they did not significantly change over the next seven months. Also as expected, these self-stereotypes predicted physical recovery, after adjusting for potentially relevant covariates. Recovery expectations acted as a mediator. These findings suggest the importance of understanding the role that positive stereotypes may play in the health of stigmatized group members.

Background Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods and Results The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, Time 2 after Group 1 hospitals received the intervention, and Time 3 after Group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses’ knowledge (N=3,013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4,587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest) (N=95,884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses’ knowledge improved significantly immediately following the intervention in both groups, but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention, and was sustained. Conclusions Online ECG monitoring education and strategies to change practice can lead to improved nurses’ knowledge, quality of care, and patient outcomes.

Purpose-To examine the appropriate use of arrhythmia, ischemia, and QTc interval monitoring in the acute care setting.Methods-We analyzed baseline data of the PULSE Trial, a multi-site randomized clinical trial evaluating the effect of implementing ECG monitoring practice standards. Research nurses reviewed medical records for indications for monitoring and observed if arrhythmia, ischemia, and QT interval monitoring were being done on 1,816 patients in 17 hospitals.Results-Almost all (99%) patients with an indication for arrhythmia monitoring were being monitored, but 85% of patients with no indication were monitored. Of patients with an indication for ischemia monitoring, 35% were being monitored, but 26% with no indication were being monitored Corresponding Author: Marjorie Funk, PhD, RN, Professor, Yale University School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536-0740, Telephone: 203-737-2346, marjorie.funk@yale.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. 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. NIH Public Access MethodsThe PULSE Trial is a 5-year (2008-2013) multi-site randomized clinical trial to evaluate the implementation of the AHA Practice Standards for ECG Monitoring 6 on nurses' knowledge, quality of care including the appropriateness of monitoring, and patient outcomes. The intervention consists of an online ECG monitoring education program and strategies to implement and sustain change in practice, led by nurse champions on each unit. The study takes place in 17 hospitals: 15 in the United States, 1 in Ottawa, Canada, and 1 in Hong Kong, China (Table 1). All hospitals received institutional review board approval. Sites include both academic medical centers and community hospitals. Hospital units involved in the study are primarily for the treatment of cardiac surgical and medical patients. They include both intensive care units (ICUs) with "hard-wire" bedside cardiac monitoring and step-down units with "wireless" telemetry monitoring.For the baseline quality of care data, our sample consisted of 2,744 observations on 1,816 patients on these adult cardiac units. One of three research nurses, who were experienced ICU nurses with expertise in ECG monitoring, visited each site for 5 days. If time permitted, they observed patients more than once during their 5-day visit. They collected data on the use and appropriateness of monitoring by reviewing the current medical records to determine if the patient had a Class I or II indication for arrhythmia, ischemia, or QT interval monitoring. The AHA Practice Standards 6 used the following rating system for indicati...

Importance: Early treatment of mild SARS-CoV-2 infection might lower the risk of clinical deterioration in COVID-19. Objective: To determine whether oral camostat mesylate would reduce upper respiratory SARS-CoV-2 viral load in newly diagnosed outpatients with mild COVID-19, and would lead to improvement in COVID-19 symptoms. Design: From June, 2020 to April, 2021, we conducted a randomized, double-blind, placebo-controlled phase 2 trial. Setting: Single site, academic medical center, outpatient setting in Connecticut, USA. Participants: Of 568 COVID-19 positive potential adult participants diagnosed within 3 days of study entry and assessed for eligibility, 70 were randomized and 498 were excluded (198 did not meet eligibility criteria, 37 were not interested, 265 were excluded for unknown or other reasons). The primary inclusion criteria were a positive SARS-CoV-2 nucleic acid amplification result in adults within 3 days of screening regardless of COVID-19 symptoms. Intervention: Treatment was 7 days of oral camostat mesylate, 200 mg po four times a day, or placebo. Main Outcomes and Measures: The primary outcome was reduction of 4-day log10 nasopharyngeal swab viral load by 0.5 log10 compared to placebo. The main prespecified secondary outcome was reduction in symptom scores as measured by a quantitative Likert scale instrument, Flu-PRO-Plus modified to measure changes in smell/taste measured using FLU-PRO-Plus. Results: Participants receiving camostat had statistically significant lower quantitative symptom scores (FLU-Pro-Plus) at day 6, accelerated overall symptom resolution and notably improved taste/smell, and fatigue beginning at onset of intervention in the camostat mesylate group compared to placebo. Intention-to-treat analysis demonstrated that camostat mesylate was not associated with a reduction in 4-day log10 NP viral load compared to placebo. Conclusions and relevance: The camostat group had more rapid resolution of COVID-19 symptoms and amelioration of the loss of taste and smell. Camostat compared to placebo was not associated with reduction in nasopharyngeal SARS-COV-2 viral load. Additional clinical trials are warranted to validate the role of camostat mesylate on SARS-CoV-2 infection in the treatment of mild COVID-19. Trial registration: Clinicaltrials.gov, NCT04353284 (04/20/20) (https://clinicaltrials.gov/ct2/show/NCT04353284?term=camostat+%2C+yale&draw=2&rank=1)