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Differences in cardiac testing resource utilization using two different risk stratification schemes

Robin J Tyner1, Melanie D Whittington2, Vanessa P Patterson2

  • 1Department of Emergency Medicine, University of Colorado School of Medicine.

The American Journal of Emergency Medicine
|January 15, 2023
PubMed

Insights

Switching from the TIMI score to the HEART score for chest pain patients in the ED increased cardiac diagnostic testing but reduced length of stay, with no change in major adverse cardiovascular events.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Health Services Research

Background:

  • Chest pain is a common emergency department (ED) presentation.
  • Risk stratification is crucial for efficient and safe chest pain management.
  • The Thrombolysis in Myocardial Infarction (TIMI) score and History, EKG, Age, Risk, Troponin (HEART) score are used for risk stratification.

Purpose of the Study:

  • To evaluate the impact of transitioning from the TIMI score to the HEART score on healthcare resource utilization in ED chest pain pathways.
  • To assess changes in cardiac diagnostic testing (CDT), length of stay (LOS), and 30-day Major Adverse Cardiovascular Events (MACE).

Main Methods:

  • Retrospective, quasi-experimental study with difference-in-differences and interrupted time series analyses.
  • Evaluated ED patients with chest pain and negative troponin, discharged from the ED.
  • Compared outcomes before (TIMI score) and after (HEART score) pathway implementation at an academic medical center and a control site.

Main Results:

  • The HEART pathway was associated with increased odds of receiving CDT (OR 2.88).
  • A significant reduction in LOS of 34 minutes was observed with the HEART pathway.
  • No significant difference in 30-day MACE was found between the TIMI and HEART cohorts.

Conclusions:

  • Transitioning to the HEART score pathway resulted in mixed effects on healthcare resource utilization.
  • Increased cardiac diagnostic testing and reduced length of stay were observed.
  • The HEART score pathway did not increase the risk of 30-day MACE.
Abstract

Keywords:
Advanced cardiac diagnostic testing (CDT)AgeChest painEKGHistoryResource utilizationRisk factorsRisk stratificationThrombolysis in myocardial infarction (TIMI)Troponin (HEART)

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