BACKGROUND: Symptoms concerning for acute coronary syndromes (ACS) such as chest pain and dyspnea are some of the most common reasons for presenting to an emergency department (ED). The HEART score (history, electrocardiogram, age, risk factors and troponin) was developed and has been externally validated in an emergency setting to determine which patients with chest pain are at increased risk for poor outcomes. Our hospital adopted a HEART score-based protocol in late 2015 to facilitate the management and disposition of these patients. In this study we aimed to analyze the effects of the adoption of this protocol. Prior studies have included only patients with chest pain. We included both patients with chest pain and patients with only atypical symptoms. METHODS: This was a retrospective chart review of two cohorts. We identified ED charts from six-month periods prior to and after adoption of our HEART score-based protocol. Patients in whom an electrocardiogram and troponin were ordered were eligible for inclusion. We analyzed data for patients with typical symptoms (chest pain) and atypical symptoms both together and separately. RESULTS: We identified 1546 charts in the pre-adoption cohort and 1623 in the post-adoption cohort that met criteria. We analyzed the first 900 charts in each group. Discharges from the ED increased (odds ratio [OR[1.56, P<.001), and admissions for cardiac workup decreased (OR 0.46, P <.001). ED length of stay was 17 minutes shorter (P = .01). Stress testing decreased (OR 0.47, P<.001). We estimate a cost savings for our hospital system of over $4.5 million annually. There was no significant difference in inpatient length of stay or catheterization rate. When analyzing typical and atypical patients separately, these results held true. CONCLUSION: After adoption of a HEART score-based protocol, discharges from the ED increased with a corresponding decrease in admissions for cardiac evaluations as well as cost. These effects were similar in patients presenting without chest pain but with presentations concerning for ACS.
BACKGROUND: Symptoms concerning for acute coronary syndromes (ACS) such as chest pain and dyspnea are some of the most common reasons for presenting to an emergency department (ED). The HEART score (history, electrocardiogram, age, risk factors and troponin) was developed and has been externally validated in an emergency setting to determine which patients with chest pain are at increased risk for poor outcomes. Our hospital adopted a HEART score-based protocol in late 2015 to facilitate the management and disposition of these patients. In this study we aimed to analyze the effects of the adoption of this protocol. Prior studies have included only patients with chest pain. We included both patients with chest pain and patients with only atypical symptoms. METHODS: This was a retrospective chart review of two cohorts. We identified ED charts from six-month periods prior to and after adoption of our HEART score-based protocol. Patients in whom an electrocardiogram and troponin were ordered were eligible for inclusion. We analyzed data for patients with typical symptoms (chest pain) and atypical symptoms both together and separately. RESULTS: We identified 1546 charts in the pre-adoption cohort and 1623 in the post-adoption cohort that met criteria. We analyzed the first 900 charts in each group. Discharges from the ED increased (odds ratio [OR[1.56, P<.001), and admissions for cardiac workup decreased (OR 0.46, P <.001). ED length of stay was 17 minutes shorter (P = .01). Stress testing decreased (OR 0.47, P<.001). We estimate a cost savings for our hospital system of over $4.5 million annually. There was no significant difference in inpatient length of stay or catheterization rate. When analyzing typical and atypical patients separately, these results held true. CONCLUSION: After adoption of a HEART score-based protocol, discharges from the ED increased with a corresponding decrease in admissions for cardiac evaluations as well as cost. These effects were similar in patients presenting without chest pain but with presentations concerning for ACS.
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2013-12-18 Impact factor: 29.690
Authors: A Jacob Six; Louise Cullen; Barbra E Backus; Jaimi Greenslade; William Parsonage; Sally Aldous; Pieter A Doevendans; Martin Than Journal: Crit Pathw Cardiol Date: 2013-09
Authors: B E Backus; A J Six; J C Kelder; M A R Bosschaert; E G Mast; A Mosterd; R F Veldkamp; A J Wardeh; R Tio; R Braam; S H J Monnink; R van Tooren; T P Mast; F van den Akker; M J M Cramer; J M Poldervaart; A W Hoes; P A Doevendans Journal: Int J Cardiol Date: 2013-03-07 Impact factor: 4.164
Authors: Leslee J Shaw; Abhinav Goyal; Christina Mehta; Joe Xie; Lawrence Phillips; Anita Kelkar; Joseph Knapper; Daniel S Berman; Khurram Nasir; Emir Veledar; Michael J Blaha; Roger Blumenthal; James K Min; Reza Fazel; Peter W F Wilson; Matthew J Budoff Journal: J Am Coll Cardiol Date: 2018-03-13 Impact factor: 24.094
Authors: Simon A Mahler; Robert F Riley; Brian C Hiestand; Gregory B Russell; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; Stephanie B Elliott; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Circ Cardiovasc Qual Outcomes Date: 2015-03-03
Authors: Adam L Sharp; Aileen S Baecker; Ernest Shen; Rita Redberg; Ming-Sum Lee; Maros Ferencik; Shaw Natsui; Chengyi Zheng; Aniket Kawatkar; Michael K Gould; Benjamin C Sun Journal: Ann Emerg Med Date: 2019-02-21 Impact factor: 5.721
Authors: Barbra E Backus; A Jacob Six; Johannes C Kelder; Thomas P Mast; Frederieke van den Akker; E Gijis Mast; Stefan H J Monnink; Rob M van Tooren; Pieter A F M Doevendans Journal: Crit Pathw Cardiol Date: 2010-09
Authors: Holli A DeVon; Larisa A Burke; Karen M Vuckovic; Trude Haugland; Ann L Eckhardt; Frances Patmon; Anne G Rosenfeld Journal: J Cardiovasc Nurs Date: 2017 Jul/Aug Impact factor: 2.083