Early data suggest new protocol to risk-stratify chest pain patients, potentially preserving resources without...

Area of Science:

• Emergency Medicine
• Cardiology
• Clinical Decision Support

Background:

• Chest pain is a common emergency department (ED) presentation, often leading to extensive and costly diagnostic workups.
• Fewer than 10% of patients with chest pain are diagnosed with acute coronary syndrome (ACS), indicating a need for improved risk stratification.
• Current diagnostic protocols result in significant healthcare expenditure, estimated at $10-$13 billion annually in the US.

Purpose of the Study:

• To evaluate the efficacy and safety of the HEART Pathway protocol for risk-stratifying emergency department patients with chest pain.
• To determine if the HEART Pathway can lead to more efficient patient disposition, reducing hospital length-of-stay and unnecessary cardiac testing.

Main Methods:

• A single-center randomized controlled trial was conducted to compare the HEART Pathway protocol with usual care.
• The HEART Pathway incorporates the HEART score, a clinical decision tool, with modified protocols including a second troponin blood test.
• Patient outcomes, including cardiac testing, length-of-stay, early discharge rates, and major cardiac complications within 30 days, were assessed.

Main Results:

• The HEART Pathway group experienced 12% fewer cardiac tests compared to the usual care group.
• Patients managed with the HEART Pathway had shorter lengths-of-stay in the hospital.
• There was a 21% increase in early discharges for lower-risk patients utilizing the HEART Pathway.
• No major cardiac complications were observed in either group within 30 days post-ED visit.

Conclusions:

• The HEART Pathway protocol demonstrates potential for safe and efficient risk stratification of chest pain patients in the ED.
• Implementation of the HEART Pathway can lead to reduced healthcare costs through decreased testing and shorter hospitalizations.
• Larger studies are underway to further validate these promising findings for broader clinical application.