Heart doctors: Give peace a chance!

"I want to stay in the hospital as long as it takes. I want to make sure . . ."

You have heard that phrase more than once. Patients and families often worry about not staying in the hospital. They worry about not being monitored.

Of course there are times when they are right, but this logic assumes that the hospital is good place to get "well."

Is a hospital environment really that soothing?

Hospitals have been placed on alert. There will be no missing things. There will be safety. And we will document every last imperfection of the human body.

Hospitals monitor stuff. They alarm and beep, which then beckon nurses to the bedside. Monitors signal disease, and they warrant action: bright lights, probing questions (are you sure you were asleep?), and most worrisome, alarms lead to testing. Alarms and beeps imply illness, and in the case of many patients with arrhythmia, illness begets illness.

This is why I think Shelley Wood, managing editor of theheart.org, picked a great presentation to write about:

"Alarming" use of unnecessary ECG monitors, ubiquitous, possibly harmful.

In the PULSE study, researchers from Yale show what any hospital-based doctor or nurse knows: that we overexpose people to monitors, alarms, and perhaps even overtreatment in the hospital. Primary investigator Dr Marjorie Funk actually called this inpatient noise pollution a "cacophony," which is defined as "a harsh and discordant bunch of sounds." Perfect.

It's kind of old-fashioned, but isn't there something to the archaic ways of treating heart disease: peace and quiet?

Take the example of a typical (not high-risk) patient with atrial fibrillation: Many get walloped in the hospital. What I mean is this: rather than reassuring the patient with atrial fibrillation, placing them in a calm, peaceful environment, perhaps giving them a cautious dose of a beta-blocker, we admit them to rooms with bright lights and beeping monitors. Then we bolus them with IV medications—none of which have an evidence base supporting any meaningful change in outcomes.

Nobody gives peace a chance. In the hospital, action is the word.

There is a real danger in all that we do in the name of better safe than sorry. There are consequences to all this action.

Thank goodness there are sane minds in research that have the common sense to study common sense. We need to question this default to action. STEMI care doesn't generalize to all of medicine. More, and faster, and louder, is not necessarily better.

Although the PULSE study won't make big headlines, the narrative here is important. If you doubt less could be more, just look at day 1 of theheart.org's coverage of the American College of Cardiology meeting. We learned that intense glycemic control in diabetics ups the risk of CHF, while raising HDL with niacin isn't the same as improving health.

We mustn't forget that the human body has powerful healing properties. If we exercise it, feed it well, and give it adequate rest, we'd be surprised what it can do.

Good care does not always require an IV, or a pill, or even a monitor.

JMM

For a different take: ECG monitoring? The lack thereof--that's what's alarming!

Your comments

	Heart doctors: Give peace a chance!
	# 1 of 4	March 10, 2013 05:11 (EDT)
	Chris McKenzie	ban heart monitors in recovery rooms after cardiac ablations I have had 3 ablations, last being a FIRM at UCLA which, so far, is successful. One of the biggest anxiety causes was the heart monitors in the recovery rooms. I was counting the audible beeps at one hospital and when they got irregular my anxiety level increased. On the monitor I could see, at another hospital, if the heart rate increased so did my anxiety level. I believe that just thinking that the rate was irregular was causing/contributing to the irregularity. Same comment for the monitor that does not beep but shows a digital display. I am glad to see a discussion of this issue. Thank you. Author's disclosure (Mar 10, 2013) I have no relevant disclosures to make in connection with this topic.
	# 2 of 4	March 13, 2013 11:37 (EDT)
	Nishith Chandra	Undue anxiety to the patient because of monitor alarms It is well known that majority of monitor alarms are 'false alarms' and the first thing the duty nurse does it to start ignoring them. But the patient is listening to these alarms and becomes worried about them. We should not put every patient in the ICU on monitors. Author's disclosure (Mar 13, 2013) I have no relevant disclosures to make in connection with this topic.
	# 3 of 4	April 3, 2013 10:08 (EDT)
	Terry Needham	Indecision What better place to pick up a new complicating illness than in a place full of sick people. With the proper motivation monitors could be used for biofeedback. Author's disclosure (Apr 3, 2013) I have no relevant disclosures to make in connection with this topic.
	# 4 of 4	April 15, 2013 08:56 (EDT)
	Chris Watson	Use them as biofeedback Am I the only one who finds them soothing? They remind me to do my relaxed breathing and un tense. I use the heart monitor as a biofeedback device and can bring myself back into rhythm fairly often and bring myself from 200bpm+/- RVR down to <110 without aditional drugs in most cases. Usually this sets off the monitor that watches my breathing as it goes "too low" but I've gotten good at tugging the monitor over to me and turning of the alarm, while leaving the monitor on. I highly recommend basic yoga breathing and relaxation. It made getting through the episodes much easier. Betablockers and Diltiazem really helped, and the abalation cured me but being able to do relaxed focused, trained, breathing made the getting to a cured stage much more comfortable. Ironically, I had vagally induced afib so if I lowered my heart rate too much when not in afib, I could trigger the afib. This does point to a disconnect between protocols, practice and what's needed for the actual health of the patient. I agree that some quiet music with a nurse nearby in a relaxed room and perhaps a fingertip oxypulse meter to prevent the paranoia from starting in is more than enough for most. For those edgy pts, 2mg of Ativan will settle them down and convert some of them. For me, I found Maalox and an Ativan worked best. Something I reverted to smuggling in with me to avoid debate on the topic with a doctor so didn't know me. While often excellent, Doctors are too quick to start the drip and not quickly explore what else might help the pt. unless led there by a proactive pt. Author's disclosure (Apr 15, 2013) I have no relevant disclosures to make in connection with this topic.

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