Double Trouble: Patients With Both True and False Arrhythmia Alarms

Abstract

Background Patients with both true and false arrhythmia alarms pose a challenge because true alarms might be buried among a large number of false alarms, leading to missed true events. Objective To determine (1) the frequency of patients with both true and false arrhythmia alarms; (2) patient, clinical, and electrocardiographic characteristics associated with both true and false alarms; and (3) the frequency and types of true and false arrhythmia alarms. Methods This was a secondary analysis using data from an alarm study conducted at a tertiary academic medical center. Results Of 461 intensive care unit patients, 211 (46%) had no arrhythmia alarms, 12 (3%) had only true alarms, 167 (36%) had only false alarms, and 71 (15%) had both true and false alarms. Ventricular pacemaker, altered mental status, mechanical ventilation, and cardiac intensive care unit admission were present more often in patients with both true and false alarms than among other patients (P < .001). Intensive care unit stays were longer in patients with only false alarms (mean [SD], 106 [162] hours) and those with both true and false alarms (mean [SD], 208 [333] hours) than in other patients. Accelerated ventricular rhythm was the most common alarm type (37%). Conclusions An awareness of factors associated with arrhythmia alarms might aid in developing solutions to decrease alarm fatigue. To improve detection of true alarms, further research is needed to build and test electrocardiographic algorithms that adjust for clinical and electrocardiographic characteristics associated with false alarms.

Computer Assisted Patient Monitoring: Associated Patient, Clinical and ECG Characteristics and Strategy to Minimize False Alarms

“…However, we found that only 9% of false arrhythmia alarms were due to poor signal quality (i.e., unanalyzable due to excessive noise, baseline wander, or leads off). Rather, our group has shown that false arrhythmia alarms are more common in patients with ECG features such as bundle branch block, a ventricular pacemaker, and/or low amplitude QRS complexes [3,24,25,38]. Of note, these features, present in only a few patients, were shown to be responsible for 60% of false alarms.…”

“…For example, in the UCSF Alarm study, of 461 ICU patients, one patient generated nearly half of the alarms [2], a problem described by others [14,17,21,22]. We found that many of these patients often have ECG features that contribute to false arrhythmia alarms, including: bundle branch block (BBB), ventricular paced rhythms, and low amplitude QRS complexes [3,23,24]. The ECG features associated with false arrhythmia alarms will be described in more detail below.…”

An annotated ventricular tachycardia (VT) alarm database: Toward a uniform standard for optimizing automated VT identification in hospitalized patients

“…Importantly, these 17 patients had nearly three-quarters of the total number of VTs. These confounders have been identified as a source of false VT in other studies (Aboukhalil et al, 2008;Drew et al, 2014;Harris et al, 2017;Nguyen et al, 2020;Pelter et al, 2020;Watanakeeree et al, 2021). Importantly, these ECG confounders are common in adult hospitalized patients.…”

Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics

“…Prior studies have identified outlier patients for both arrhythmia and other physiologic alarms (e.g. vital signs), a problem described as ‘alarm flood’ (Allan et al, 2017; Drew et al, 2014; Harris et al, 2017; Nguyen et al, 2020; Yeh et al, 2020). To reduce alarm fatigue in this situation targeted alarm strategies (e.g.…”

“…We were somewhat surprised that the remaining PVC types were infrequent, ranging from 6% (PVC/minutes) to 2% (VT >2). However, it is worth noting that the maximum number for all types was high ( Harris et al, 2017;Nguyen et al, 2020;Yeh et al, 2020).…”