Effect of a HEART Score Best Practice Alert on Discharge Decisions and Outcomes of Patients Presenting to an...

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Decision Support

Background:

• Contemporary chest pain (CP) evaluation relies on high-sensitivity troponin (hsTn) accelerated diagnostic protocols (ADPs).
• The added value of bioclinical risk scores, like the HEART score, to hsTn ADPs remains unclear.

Purpose of the Study:

• To assess the impact of an automated best practice alert (BPA) for HEART score capture on emergency department (ED) discharge decisions and outcomes.
• To evaluate the integration of the HEART score BPA with hsTn ADP in chest pain management.

Main Methods:

• Retrospective cohort study comparing patients before and after the implementation of a HEART score BPA.
• Analysis of discharge rates and 30-day major adverse cardiac event (MACE) rates, stratified by hsTnT levels and HEART score.
• Utilized data from a 6-month pre-BPA period and a 10-month post-BPA period.

Main Results:

• The post-BPA cohort showed a higher ED discharge rate (5.5% vs. 3.6%, p < 0.001).
• Low-risk HEART scores correlated with lower MACE rates (0.6% vs. 1.6%, p = 0.001), while high-risk scores correlated with higher MACE rates (6.6% vs. 1.6%, p < 0.001).
• The HEART score demonstrated significant discriminatory power for MACE in patients with hsTnT levels between 12-51 ng/dL.

Conclusions:

• Integrating the HEART score BPA with hsTnT ADP increased ED discharge rates.
• This approach improved risk stratification for 30-day MACE, especially in patients with moderate hsTnT elevations.
• The HEART score aids in refining discharge decisions for chest pain patients within accelerated diagnostic protocols.