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Retrospective analysis of HEART Score results in cost saving
Sandra A Arnold1, Cathy Grant2, Kathy Magdic2
1DNP, Veterans Administration Health Care System (VAPHS), Pittsburgh, Pennsylvania.
Insights
The HEART Score safely identifies low-risk patients with chest pain in the Veterans Affairs system, reducing costs and preventing major adverse cardiac events. This tool aids in efficient emergency department evaluation.
Area of Science:
- Emergency Medicine
- Cardiology
- Health Services Research
Background:
- Chest pain is a common emergency department complaint with a wide differential diagnosis.
- Many patients are admitted for cardiac evaluation, though acute coronary syndrome (ACS) is infrequent.
- Current assessment lacks a standardized tool for low-risk chest pain in the Veterans Affairs system.
Purpose of the Study:
- To evaluate the utility of the HEART Score for undifferentiated chest pain in the Veteran population.
- To determine if the HEART Score can safely identify low-risk patients in this demographic.
- To assess potential cost savings associated with HEART Score implementation.
Main Methods:
- Retrospective analysis of 197 patients presenting with chest pain at VAPHS over six months.
- Calculation of HEART Scores for all identified patients.
- Evaluation of low-risk patients (HEART Score 0-3) for major adverse cardiac events (MACE) and cost-effectiveness.
Main Results:
- Approximately 28% of patients were identified as low-risk using the HEART Score.
- No major adverse cardiac events (MACE) were recorded in the low-risk group.
- Significant cost savings were observed compared to usual care ($1,145 vs. $4,700 per patient).
Conclusions:
- The HEART Score is a safe and effective tool for identifying low-risk chest pain patients in the Veteran population.
- Implementation of the HEART Score can lead to substantial cost reductions in emergency department care.
- This validated tool supports efficient resource utilization and improved patient management for chest pain.
Background And Purpose:
Chest pain (CP) is one of the most frequent chief complaints of patients presenting to the emergency department (ED). Diagnoses range from life-threatening acute coronary syndrome (ACS) to less concerning musculoskeletal injury. Patients are frequently admitted for comprehensive cardiac evaluation. However, it is estimated that <10% are diagnosed with ACS. Identifying low-risk patients who can be safely discharged from the ED results in lower cost burden and less patient days. The HEART Score is a recently validated tool for undifferentiated CP in the ED used to identify low-risk patients. The purpose of this project was to ascertain if the HEART Score could be utilized in the Veteran population for the evaluation of undifferentiated chest pain.
Local Problem:
There is no standard assessment tool used in the ED at the Veterans Administration Pittsburgh Healthcare System (VAPHS) to evaluate CP in low-risk patents.
Methods:
As part of a quality improvement initiative, a retrospective analysis was performed on patients presenting to the ED with CP over a 6-month period. A total of 197 VAPHS patients were identified through the computerized medical record system. HEART Scores were calculated for each patient. Patients scored as low risk (score of 0-3) were further evaluated for major adverse cardiac events (MACE) and cost saving.
Conclusions:
Approximately 28% (56) of the patients presenting to the ED with CP were at low risk based on the HEART Score. There were no MACE. There were cost savings compared with usual care ($1,145 vs. $4,700).
Implications For Practice:
The HEART Score can be safely used to identify low-risk patients and result in cost savings for Veteran population.
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