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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
PubMed

Insights

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.
Abstract

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