Clinical Care Delivery in Chest Pain Patients Without an Acute Coronary Syndrome-A Retrospective Cohort Study

Background: Chest pain is a prevalent and critical complaint among patients in emergency departments (EDs) across the United States. Professional societies have refined clinical guidelines to establish the most effective diagnostic pathways for identifying obstructive coronary artery disease. However, many healthcare systems do not adhere to the guideline-validated clinical pathways and instead order repeat diagnostic testing. This study evaluated the efficiency of care delivered to chest pain patients in our tertiary medical center. Methods: We performed a retrospective chart review of patients presenting to our ED with acute chest pain between November and December 2022, collecting information about chest pain, the testing received, and their outcomes. The data were then reviewed to determine clinical practice patterns. Results: We included 342 patients, with a mean age of 54 years; 54.7% of study participants were females. Patients who were eventually admitted from the ED (46.5%, n = 159) were either under observation or inpatient status. Furthermore, 16.6%, n = 57, of patients had an ischemic evaluation within the preceding year. Physicians documented a HEART score in 24.6%, n = 84 of the patients. While HEART score is a considerable factor utilized by admitting physicians to triage incoming patients, 39%, n = 62, of all admitted patients had a low HEART score (<3) and a negative ischemic evaluation within the past year. Conclusions: This single-center retrospective analysis of care delivery for non-ACS (acute coronary syndrome) chest pain patients demonstrated that the HEART score was not thoroughly documented in the study population. This resulted in an overperformance of inpatient ischemic testing, with an increased length of stay and costs for the institution and healthcare system. This study serves as a quality improvement initiative to explore similar data within their institutions and as a reminder of the importance of utilizing validated clinical pathways to streamline clinical care and reduce healthcare costs.