706 - Telemetry Monitoring Facilitating Comprehensive Rehabilitation in Patients with Pre-existing Heart Conditions: A Case Report

Case Diagnosis: Atrial fibrillation with rapid ventricular response

Case Description: 90-year-old female who was admitted with gangrene of the left foot status-post partial foot amputation The patient completed a nine-day comprehensive rehabilitation program, but on her second day of inpatient rehabilitation, she developed atrial fibrillation with rapid ventricular response (heart rate: 139) and hypotension (blood pressure: 83/44). Telemetry monitoring was initiated and the emergency department was consulted for acute stabilization. Patient underwent chemical cardioversion with intravenous Diltiazem and her vitals signs stabilized. She was started on scheduled amiodarone and continued on metoprolol for rate control, per cardiology recommendations. Patient remained on telemetry monitoring for the remainder of her rehabilitation stay and was discharged home without any further complications.

Discussions: This case highlights the value of having telemetry monitoring in inpatient rehabilitation facilities (IRFs) to enhance patient safety and quality of care. Acute care transfers (ACTs) disrupt continuity of care and therapy in IRFs, leading to increased patient distress and use of resources. Transfers to local emergency rooms frequently result in patients being admitted to acute care hospitals, resulting in extended interruptions in rehabilitation programs and delayed achievement of rehab goals. Fortunately, in the case presented, the patient was able to successfully complete her rehabilitation program despite a life-threatening cardiac event with minimal inconvenience to her or our healthcare system. This was possible due to the availability of telemetry monitoring in our IRF.

Conclusions: There is no case to date reporting the favorable outcome of an IRF patient with acute cardiac decompensation who successfully completed their comprehensive rehabilitation program without significant delay or need for ACT. This emphasizes the value of having access to telemetry monitoring in IRFs, which can help limit ACTs and thus enhance the overall quality of care provided to rehab patients.