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Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions
Brandon R Allen1, Grant G Simpson1,2, Ideen Zeinali1
1From the Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL.
Insights
Implementing the HEART score pathway safely reduced emergency department admissions for low-risk chest pain patients. This approach decreased unnecessary testing and readmissions without impacting major adverse cardiac events, improving patient care and lowering costs.
Area of Science:
- Emergency Medicine
- Cardiology
- Health Services Research
Background:
- Chest pain is a common emergency department complaint with risks of missed diagnosis or unnecessary testing.
- The HEART score aids in identifying low-risk acute coronary syndrome patients for safe discharge.
- Current practices may lead to increased healthcare costs and patient risks due to avoidable admissions and testing.
Purpose of the Study:
- To evaluate the impact of integrating the HEART score into a low-risk chest pain decision pathway on patient admissions and outcomes.
- To assess the safety and efficacy of a modified HEART score implementation in a large-scale, retrospective observational study.
- To determine the effect on healthcare resource utilization, including diagnostic testing and hospital readmissions.
Main Methods:
- Retrospective observational pre/post study design involving 31,060 patients over 30 months.
- Incorporation of a modified HEART score calculation tool into the electronic medical record.
- Analysis of discharge rates, major adverse cardiac events, return admissions, length of stay, and coronary computed tomography angiogram utilization.
Main Results:
- Significant increase in discharges for low-risk chest pain patients (21% relative increase; p < 0.0001).
- No significant difference in major adverse cardiac events between pre- and post-implementation periods.
- Reduced 30-day (4.65% fewer; p = 0.009) and 60-day (3.78% fewer; p = 0.020) return admissions.
- Substantial decrease in monthly coronary computed tomography angiograms (64%; p < 0.0001).
Conclusions:
- The HEART pathway effectively and safely lowers admissions for low-risk chest pain patients in emergency departments.
- Adoption of the HEART pathway can lead to significant reductions in healthcare costs and resource utilization.
- This strategy supports the safe discharge of selected chest pain patients, optimizing emergency department workflow and patient outcomes.
Abstract:
Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions. The modified HEART score calculation tool was incorporated in our electronic medical record. A significant increase in discharges of low-risk chest pain patients (relative increase of 21%; p < 0.0001) in the postimplementation period was observed with no significant difference in the rates of major adverse cardiac events between the pre and post periods. There was a decrease in the amount of return admissions for 30 days (4.65% fewer; p = 0.009) and 60 days (3.78% fewer; p = 0.020). No significant difference in length of stay was observed for patients who were ultimately discharged. A 64% decrease in monthly coronary computed tomography angiograms was observed in the post period (p < 0.0001). These findings support the growing consensus in the literature that the adoption of the HEART pathway or similar protocols in emergency departments, including at large and high-volume medical institutions, can substantially benefit patient care and reduce associated health care costs.
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