The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest...

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• Chest pain is a common emergency department (ED) presentation requiring careful evaluation.
• Optimizing resource utilization in EDs is crucial for efficient healthcare delivery.
• The HEART Score and accelerated diagnostic protocols (ADPs) offer structured approaches to chest pain assessment.

Purpose of the Study:

• To evaluate the impact of the HAS-Choice pathway on patient disposition in an ED setting.
• To determine if the intervention improves resource utilization while maintaining patient safety.
• To assess changes in 30-day bounce back rates and major adverse cardiac events (MACE).

Main Methods:

• A single-center, prospective cohort study with a historical control group.
• Inclusion of adult patients (≥21 years) presenting to the ED with chest pain.
• Analysis of patient disposition, 30-day ED bounce back, and MACE using multivariate logistic regression.

Main Results:

• Implementation of HAS-Choice led to a significant decrease in inpatient admissions (4.8% vs 6.5%) and observation admissions (41.5% vs 49.1%).
• The odds of discharge increased by 40% (OR=1.40) and the odds of admission decreased by 30% (OR=0.70) post-implementation.
• No statistically significant difference in 30-day ED bounce back; MACE rates remained low (<1%), with decreased mortality.

Conclusions:

• The HAS-Choice pathway, integrating an ADP and HEART score with shared decision-making, safely reduces hospital admissions for chest pain.
• This approach enhances resource utilization in the ED without compromising patient safety or increasing MACE.
• Shared decision-making tools can be effectively implemented in ED settings for chest pain evaluation.