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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.