Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis

Abstract

ObjectiveTo investigate which risk score (TIMI score or HEART score) identifies the largest population of low-risk patients at the emergency department (ED). Furthermore, we retrospectively calculated the corresponding expected decrease in medical consumption if these patients would have been discharged from the ED.MethodsWe performed analyses in two hospitals of the multicentre prospective validation study of the HEART score, executed in 2008 and 2009. Patients with chest pain presenting to the ED were included and information was collected on major adverse cardiac events (MACEs) and on hospital admissions and diagnostic procedures within 6 weeks. The TIMI and HEART score were calculated for each patient.ResultsWe analysed 640 patients (59% male, mean age of 60, cumulative incidence of MACE 17%). An estimated total of €763 468 was spent during follow-up on hospital admission and diagnostic procedures. In total, 256 (40%) patients had a HEART score of 0–3 and were considered low risk (miss rate 1.6%), a total of €64 107 was spent on diagnostic procedures and hospital admission after initial presentation in this group. In comparison, 105 (16%) patients with TIMI score of 0 were considered low risk (miss rate 0%), with a total of €14 670 spent on diagnostic procedures and initial hospital admission costs. With different cut-offs for low risk, HEART 0–2 (miss rate 0.7%), would have resulted in a total of €25 365 in savings, compared with €71 905 when an alternative low risk cut-off for TIMI of TIMI≤1 would be used (miss rate 3.0%).ConclusionsThe HEART score identifies more patients as low risk compared with the TIMI score, which may lead to a larger reduction in diagnostic procedures and costs in this low-risk group. Future studies should prospectively investigate whether adhering to the HEART score in clinical practice and early discharge of low-risk patients is safe and leads to a reduction in medical consumption.

Comparative prospective study of the performance of chest pain scores and clinical assessment in an emergency department cohort in Singapore

“…The major adverse cardiovascular events rate in this study (11.3%) is similar to that found in other studies (9%–17%, depending on country and institution) 14–18 . HEART was found to be the most reliable of the chest pain scores, EDACS trailed closely, and GRACE fared the poorest.…”

“…Currently, few attending emergency physicians in The major adverse cardiovascular events rate in this study (11.3%) is similar to that found in other studies (9%-17%, depending on country and institution). [14][15][16][17][18] HEART was found to be the most reliable of the chest pain scores, EDACS trailed closely, and GRACE fared the poorest. This was likely because GRACE, like TIMI, was first developed for patients with established acute coronary syndrome rather than undifferentiated chest pain.…”

The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

“…There are alternate prognostic prediction models in patients with possible ACS to undergo derivation and validation in ED patients [ 11 , 12 ]. However, the HEART score is the only model to be evaluated by multiple independent research groups in both validation and clinical impact studies [ 15 – 20 ]. In addition, the HEART score outperforms alternate prediction models in comparison studies [ 15 , 21 ].…”

“…However, the HEART score is the only model to be evaluated by multiple independent research groups in both validation and clinical impact studies [ 15 – 20 ]. In addition, the HEART score outperforms alternate prediction models in comparison studies [ 15 , 21 ]. The HEART score is also intuitive to the EP, relying on elements of clinical experience rather than the sometimes less accessible, yet statistically valid predictors seen in other models [ 8 ].…”

Comparison of nine coronary risk scores in evaluating patients presenting to hospital with undifferentiated chest pain

“…In comparing risk scores developed from populations with chest pain irrespective of final diagnosis (HEART, NACPR, ADAPT, FPR, EDACS) with those developed in populations with confirmed ACS at discharge (GRACE, TIMI, m.TIMI, PURSUIT), our results confirm that the former, in particular HEART and NACPR, demonstrated superior discriminative performance. Other studies also rate TIMI,24 modified TIMI,10,25 and GRACE10,28 as inferior in stratifying risk.…”