Why Won't Emergency Physicians Discharge Patients With a Low HEART Score From an Observation Unit Without Further
Margarita Pena1, Joseph Tsao1, Tunde Falaiye1
1From the Department of Emergency Medicine, Ascension St. John Hospital, Detroit, MI.
Critical Pathways in Cardiology
|August 10, 2020
Summary
Emergency physicians hesitate to discharge low-risk chest pain patients using the HEART score due to concerns about follow-up, risk factors, and symptoms, despite its validation for safe discharge.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Risk Stratification
Background:
- The HEART score (History, Electrocardiogram, Age, Risk Factors, Troponin) is validated for safely discharging low-risk chest pain patients from the emergency department (ED).
- Despite evidence, ED physicians show reluctance in discharging patients solely based on a low HEART score (0-3).
Purpose of the Study:
- To investigate the specific reasons behind emergency department physicians' reluctance to discharge low-risk HEART score patients from observation units without further testing.
- Identify factors influencing physician decisions regarding outpatient follow-up for chest pain patients with low HEART scores.
Main Methods:
- A prospective, cross-sectional analysis was conducted in an urban emergency department observation unit (EDOU).
- ED physicians completed questionnaires detailing patient HEART scores and suitability for immediate outpatient follow-up.
- Physicians indicated reasons why patients were deemed unsuitable for outpatient stress testing or follow-up within 72 hours.
Main Results:
- Out of 279 patients, 42% had a low HEART score (0-3).
- Over half (54.7%) of these low-risk patients were considered not good candidates for outpatient follow-up.
- Key concerns cited included poor patient follow-up (14%), concerning risk factors (14%), and concerning symptoms (11%).
Conclusions:
- Emergency physicians in this urban setting frequently identify barriers to discharging low-risk HEART score patients.
- Concerns regarding follow-up, patient risk factors, and symptom presentation influence decisions against immediate outpatient management.
- Further evaluation or closer monitoring may be preferred by clinicians for these patients despite a low HEART score.
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