Cardiac Score May Help to Improve Patient Safety, Costs

Use of the HEART score (History, Electrocardiogram, Age, Risk factors, and initial Troponin) when patients with chest pain are initially assessed may lead to less use of health care resources while still ensuring patient safety.

Using a stepped-wedge, cluster randomized trial, researchers assessed the use of the HEART score on patient outcomes and health care resources in emergency departments (ED) in 9 Dutch hospitals. Patients included in the trial presented to the EDs in 2013 and 2014.
_______________________________________________________________________________________________________________________________________________________________________
RELATED CONTENT
Study: CVD Biomarkers are Linked to CMI-Related Brain Injury 
Very Low LDL Cholesterol Levels Can Decrease CVD Risk
_______________________________________________________________________________________________________________________________________________________________________

The 9 hospitals started with usual care and were randomly switched (1 hospital every 6 weeks) to using the HEART score to help guide patient treatment. In total, 3,648 patients were included in the study, with 1,827 in the usual care group and 1,821 in the HEART care group.

Researchers found that HEART care was noninferior to usual care in terms of safety, which was measured as incidence of major adverse cardiac events (MACE) at 6 weeks. Approximately 19% of patients receiving HEART care experienced adverse events at 6 weeks, compared with 22% of usual care patients. Among low-risk patients, MACE incidence was 2%.

However, the study was limited by physicians’ reluctance to alter their usual care recommendations, including admission and diagnostic tests, in patients who were considered low risk according to HEART score. Thus, use of health care resources was similar between the 2 groups in the study.

If health care practices were changed in accordance with HEART score recommendations, approximately $40 million could be saved, according to a cost-effectiveness analysis.

—Lauren LeBano

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. Ann Intern Med. Published online April 25, 2017.