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Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster

Judith M Poldervaart1, Johannes B Reitsma1, Barbra E Backus1

  • 1From University Medical Center Utrecht and Diakonessenhuis Utrecht, Utrecht; University of Twente, Enschede; Medical Center The Hague, The Hague; Vu University Medical Center, Amsterdam; Amstelland Hospital, Amstelveen; Catharina Hospital, Eindhoven; St. Antonius Hospital, Nieuwegein; Zuyderland Hospital, Heerlen; Gelderse Vallei Hospital, Ede; Tergooi Hospital, Hilversum; Groene Hart Hospital, Gouda; Meander Medical Center, Amersfoort; Radboud University Medical Center, Nijmegen; Maastricht University Medical Center, Maastricht; Gelre Hospital, Apeldoorn; and Zuwe Hofpoort Hospital, Woerden, the Netherlands.

Annals of Internal Medicine
|April 25, 2017
PubMed

Insights

The HEART score is safe for assessing chest pain patients, reducing major adverse cardiac events. However, its impact on healthcare resource use was limited, possibly due to physician adherence issues.

Area of Science:

  • Cardiology
  • Clinical Decision Support
  • Health Services Research

Background:

  • The HEART score aids in stratifying chest pain patients by short-term risk of major adverse cardiac events (MACEs).
  • Its real-world impact on clinical practice and healthcare resource utilization remained unclear.

Purpose of the Study:

  • To evaluate the effect of implementing the HEART score on patient outcomes.
  • To assess the impact of the HEART score on healthcare resource utilization.

Main Methods:

  • A stepped-wedge, cluster randomized trial was conducted across 9 Dutch emergency departments.
  • Unselected chest pain patients were managed with usual care or HEART score-guided care over 2013-2014.
  • A noninferiority margin of 3.0% absolute increase in MACEs within 6 weeks was set for safety.

Main Results:

  • The 6-week MACE incidence was 1.3% lower with HEART score use compared to usual care, remaining within the noninferiority margin.
  • In low-risk patients, MACE incidence was 2.0%.
  • No significant differences were found in early discharge, readmissions, or healthcare visits.

Conclusions:

  • The HEART score is a safe tool for initial chest pain assessment.
  • Limited impact on healthcare resource use was observed, potentially due to physician hesitancy in adhering to HEART score recommendations for low-risk patients.
Abstract

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