1. The findings of this cluster randomized trial suggest that it is safe to use the HEART score during initial assessment of chest pain patients in the emergency department (ED).
2. Using the HEART score did not result in statistically significant differences in early discharge, readmissions, or recurrent ED visits.
Evidence Rating Level: 1 (Excellent)
Study Rundown: One of the challenges of managing patients with chest pain is deciphering between those with acute coronary syndrome and those with noncardiac conditions. The reference standard for this investigation, coronary angiography, is a costly option that has a potential risk of complications. One potential alternative to coronary angiography is the HEART score, which is based on 5 key elements: history, electrocardiogram, age, risk factors, and troponin. The authors of this study aimed to measure the effect of use of the HEART score on patient outcomes and use of health care resources. Certain limitations must be considered with respect to this study. Of note, small differences in baseline characteristics between study periods were observed for patients involved with HEART care versus usual care. As well, due to external causes, the authors did not reach the number of patients in their initial sample size calculations. In general, the results of this study indicate that HEART may be a useful score to risk stratify patients, but needs to be used more frequently in the ED to determine whether it has a positive impact on healthcare resources.
Relevant Reading: The HEART Score: A New ED Chest Pain Risk Stratification Score
In-Depth [randomized controlled trial]: The authors conducted a prospective, stepped-wedge cluster randomized trial. In total, 3648 patients with chest pain were included, where 1827 received usual care and 1821 received HEART care. Comparing the usual with HEART care patients, it was observed that the 6-week interval of major adverse cardiac events (MACEs) during HEART care was 1.3% lower than during usual care (upper limit of the 1-sided 95%CI 2.1%; within the non inferiority margin of 3.0%). However, no statistically significant differences in early discharge, readmissions, or recurrent emergency department visits, outpatient visits, or visits to general practitioners were observed.
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