Can ED chest pain patients with intermediate HEART scores be managed as outpatients?

Moustapha, Aisha; Mah, Alicia C.; Roberts, Lauren; Leach, Andrew; Kaban, Glenda; Zimmermann, R.; Shavadia, Jay; Orvold, Jason; Mondal, Prosanta; Martin, Lynsey J

doi:10.1007/s43678-022-00355-4

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…Finally, a recent Canadian analysis of early ED discharge of intermediate‐risk chest pain patients produced similar findings to our study 21 . The investigators described similar ED return rates (6.1% vs. 7.2% at 30 days in our study) and no mortalities at 6 weeks (vs. an unpreventable death in our population), but with higher rates of ACS (5.4% as compared to 0% in our population at 30 days).…”

Section: Discussionsupporting

confidence: 88%

“…As cardiologist investigators performed the majority of the chart reviews, it would be less likely for retrospectively calculated HEART scores to be systematically increased. Finally, this proportion of missing HEART scores is similar to rates previously published in like populations 21 . Third, a significant number of moderate‐risk HEART score patients did not follow up in our postdischarge clinic.…”

Section: Limitationssupporting

confidence: 86%

“…Finally, a recent Canadian analysis of early ED discharge of intermediate-risk chest pain patients produced similar findings to our study. 21 The investigators described similar ED return rates (6.1% vs.…”

Section: Discussionmentioning

confidence: 86%

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Early emergency department discharge for intermediate heart score patients presenting for chest pain

Pawlikowski,

Hubbard,

Krauss

et al. 2023

JACEP Open

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Study ObjectiveThe use of the HEART score to risk stratify patients for short‐term major adverse cardiac events in the emergency department (ED) setting is well established. Although discharge to home for low‐risk HEART score patients is widely accepted as safe practice, there are limited outcomes data on moderate‐risk HEART score patients discharged to home. We investigated the safety of discharging moderate‐risk HEART score patients to home from the ED with established early cardiology follow‐up.MethodsWe performed a retrospective cohort analysis of patients presenting to the ED with chest pain from April 2020 through December 2020. Patients were evaluated in the ED and underwent serial conventional troponin testing and electrocardiogram (ECG). Clinicians calculated a HEART score and employed shared decision‐making with moderate‐risk patients (score 4–6), offering hospital admission versus discharge home with a formalized process for rapid cardiology follow‐up (within 2 business days). We assessed the frequency of acute myocardial infarction or death at 30 days and before cardiology follow‐up.ResultsDuring our study period, 2939 patient encounters were screened for chest pain. Of these, 333 of 547 eligible moderate‐risk HEART score patients were referred for rapid follow‐up. The median time to follow‐up appointment was 2.9 business days (interquartile range 1.3, 6.5), and 264 (79%) of patients kept their follow‐up appointment. One patient (0.3%) suffered death within 30 days, before cardiology follow‐up. There were no myocardial infarctions.ConclusionsThese results suggest that moderate‐risk HEART score patients may be considered for discharge from the ED with rapid cardiology follow‐up. Formalizing processes to facilitate these early evaluations may represent a viable alternative to hospital admission, without diminishing patient outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Limitationssupporting

confidence: 86%

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Early emergency department discharge for intermediate heart score patients presenting for chest pain

Pawlikowski,

Hubbard,

Krauss

et al. 2023

JACEP Open

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“…In this edition of the Canadian Journal of Emergency Medicine, Moustapha and colleagues present a potentially inspiring report about their use of rapid-access clinics for chest pain to avoid hospital admission and observation of patients presenting to the ED with symptoms suggestive of an acute coronary syndrome (ACS) [1]. What is notable about their study, and why the authors should be particularly congratulated, is that they report the impact of an ED management strategy as implemented in real-life care.…”

mentioning

confidence: 99%

An excellent demonstration of how healthcare systems can redesign patient management strategies

Than

Wakai

2022

Can J Emerg Med

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“…This Canadian multicentre retrospective study examined outcomes of patients with intermediate-risk HEART (history, electrocardiogram, age, risk factors, troponin) scores directly referred from ED for outpatient rapid access chest pain clinic (RACPC) management, which allows cardiologists follow-up of patients with chest pain of possible cardiac origin 1. The primary outcome was a major adverse coronary event (MACE) at 6 weeks from presentation, defined as ‘death, ACS, stroke, coronary angiogram, or revascularisation’ (for which the American College of Emergency Physicians gave an acceptable missed diagnosis rate of 1%–2%).…”

Section: Can Ed Chest Pain Patients With Intermediate Heart Scores Be...mentioning

confidence: 99%

Journal update monthly top five

et al. 2022

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Word count including subheadings & bottom line (excluding references): 1485This month's update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.The papers are ranked as: Worth a peek-interesting, but not yet ready for prime time. Head turner-new concepts. Game changer-this paper could/should change practice.

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Can ED chest pain patients with intermediate HEART scores be managed as outpatients?

Cited by 6 publications

References 31 publications

Early emergency department discharge for intermediate heart score patients presenting for chest pain

Early emergency department discharge for intermediate heart score patients presenting for chest pain

An excellent demonstration of how healthcare systems can redesign patient management strategies

Journal update monthly top five

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