Abstract 20838: Aggressive Management of Bradycardia is Associated With Improved Clinical Outcomes and Shorter Length of Stay: A Comparison of Two Academic Centers
Introduction: Bradycardia symptoms range from fatigue to cardiac arrest. However, it is unclear to what extent management affects clinical outcomes. The purpose of the current study was to perform a retrospective analysis of the management of bradycardic patients at two tertiary care centers and to determine if the management styles resulted in any differences in clinical outcomes.
Hypothesis: Aggressive management of bradycardia is associated with improved clinical outcomes.
Methods: We retrospectively reviewed the charts of 555 patients from Mayo Clinic Rochester (n=358) and Mayo Clinic Scottsdale (n=197) who presented to the ED with bradycardia (heart rate ≤50 bpm) secondary to a mechanism other than sinus with 1:1 AV conduction from 2010 through 2015. Patients were categorized by treatment strategy: monitoring, medical therapy alone, medical therapy plus transcutaneous pacing (TCP), and medical therapy plus temporary transvenous pacemaker (TPM). Significant bradycardic events were defined as pauses >5 seconds, syncope, or cardiac arrest.
Results: Presenting rhythms related to heart block (2nd degree Mobitz I & II, 2:1, 3rd degree) occurred in 40% of patients whereas non-sinus rhythms (slow atrial fibrillation/flutter, junctional) occurred in 60% of patients with a comparable distribution between sites (P=0.17). Of the patients at the Rochester site, 81% were monitored, 9% received medical therapy alone, 1% had TCP, and 9% had TPM compared to the Scottsdale site where 67% were monitored, 18% received medical therapy alone, 1% had TCP, and 14% had TPM (P=0.003). ICU level of care was provided to 27% of patients at the Rochester site and to 33% of patients at the Scottsdale site (P=0.21). Significant bradycardic events occurred in 9% of patients at the Rochester site compared to 2% of patients at the Scottsdale site (P=0.012) with no difference in in-hospital mortality (4% vs. 2%, P=0.14). Mean length of stay at the Rochester site was 3 days compared to 1.5 days at the Scottsdale site (P<0.001).
Conclusions: Therapy for bradycardia was more aggressive at the Scottsdale site and was associated with fewer adverse events and shorter length of stay. Our data suggest that aggressive management of bradycardia is associated with improved clinical outcomes.
Author Disclosures: V. Abrich: None. R. Le: None. P. Friedman: None. Y. Cha: None. D. Nestler: None. E.H. Yang: None. G. Barsness: None.
- © 2016 by American Heart Association, Inc.