ST-Segment Monitoring Benefits, Barriers, and Pathways to Acceptance

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Literature review

In recent years, peer-reviewed papers have described how continuous ST-segment review can detect cardiac events in ED or ICU patients whose ECGs appear normal and may not complain of symptoms. These peer-reviewed papers present evidence that ST-segment monitoring can help clinicians detect potentially life-threatening conditions, investigate the causes, and start treatment sooner.

And yet, adoption of ST-segment monitoring is far from universal. This report draws on information from medical journal articles, papers and practice guidelines that reflect recent findings and clinical approaches related to ST segment monitoring.

Practice guidelines from various entities have identified a variety of patient groups that can benefit from continuous ST-segment monitoring. They include:

• Patients experiencing acute myocardial infarction or Acute Coronary Syndrome (ACS)
• Patients after coronary artery intervention to detect patency after thrombolytic therapy or primary angioplasty
• Patients in early ACS phases who arrive with chest pain or anginal-equivalent syndromes
• Patients after percutaneous coronary intervention who have not achieved optimum perfusion
• Patients who may have a variant angina

Despite abundant evidence in its favor, ST-segment monitoring is routine practice in only about half of critical care units in the United States. Barriers to its adoption include:

• Lack of physician awareness and interest
• Absence of standard ST-segment monitoring protocols
• Lack of nurse training in monitoring and interpretation
• Concern about false alarms

Specific ways to overcome these barriers include:

• Better education and training of nurses and physicians
• Greater interdisciplinary cooperation
• Hospitals’ adoption of written ST-review practice standards and protocols
• ST-segment monitoring technology that is easy for caregivers to use and understand

Clinical experience and research show that ST-segment monitoring unquestionably has a place in the care of cardiac patients.