HEART Score Impact for Patients with Chest Pain in ED

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There were no significant differences in early discharge, readmissions, recurrent emergency department visits, outpatients visits, or visits to general practitioners.
There were no significant differences in early discharge, readmissions, recurrent emergency department visits, outpatients visits, or visits to general practitioners.

HealthDay News — Use of the History, Electrocardiogram, Age, Risk factors, and initial Troponin (HEART) score is safe but has a limited effect on health care resource use among patients presenting at the emergency department with chest pain, according to a study published in the Annals of Internal Medicine.

Judith M. Poldervaart, MD, PhD, from University Medical Center Utrecht in the Netherlands, and colleagues examined the effects of use of the HEART score on patient outcomes and health care resource use in a stopped-wedge, cluster randomized trial in emergency departments at 9 hospitals. Data were included for 3648 unselected patients with chest pain presenting at emergency departments in 2013 and 2014 (1827 patients received usual care, and 1821 received HEART care).

The researchers found that the 6-week incidence of major adverse cardiac events (MACE) was 1.3% lower during HEART care than during usual care (upper limit of the one-sided 95% confidence interval, 2.1%, within noninferiority margin of 3%). The incidence of MACEs was 2% in low-risk patients (95% confidence interval, 1.2% to 3.3%). There were no significant differences in early discharge, readmissions, recurrent emergency department visits, outpatients visits, or visits to general practitioners.

"Using the HEART score during initial assessment of patients with chest pain is safe, but the effect on health care resources is limited, possibly due to nonadherence to management recommendations," the researchers write.

One researcher disclosed ties to pharmaceutical and diagnostic companies.

Reference

Poldervaart JM, Reitsma JB, Backus BE, et al. Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial [published online April 25, 2017]. Ann Intern Med. doi: 10.7326/M16-1600

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