HEART Pathway protocol reduces unnecessary angiograms in low-risk ED patients
A new protocol—HEART Pathway—can identify low-risk emergency department (ED) patients with chest pain who can be discharged without stress testing or angiography, according to results of a Sept. 28 study published in Circulation.
“Given its ability to reduce the utilization of health care resources, the protocol may provide a model for health systems to provide safe and high-value care to emergency room patients with chest pain at lower cost,” said lead author, Simon A. Mahler, MD, with Wake Forest Baptist Medical Center, in a prepared statement.
Researchers looked at electronic health record and insurance claims data of more than 8,000 patients with possible acute coronary syndrome from three hospital ED's. A total of 3,713 received care 12 months before using the HEART Pathway, and 4,761 were cared for 12 months after the protocol was implemented.
Upon a 30-day follow-up, the protocol identified more than 30 percent of patients as low-risk. Additionally, implementation increased early ED discharge by 5.6 percent, reduced stress testing and angiography at follow-up by 3.8 percent and decreased median index visit length of stay by 2.1 hours.
“This study may provide a model for U.S. health systems to provide safe and high-value care to the 8-10 million patients who present to a U.S. ED with acute chest pain each year,” Mahler and colleagues wrote. “Our data adds to a growing body of evidence suggesting that current practice guidelines should be changed, so that stress tests or cardiac imaging are no longer recommended for most low-risk patients presenting to the ED with chest pain.”
The HEART protocol produces a score based on four components: patient history, electrocardiogram reading, age and risk factors, and is combined with two blood tests which measure troponin levels.
While the protocol has demonstrated potential to reduce unnecessary imaging, procedures and reduce healthcare costs, the authors believe it cannot be used as a substitute for clinical judgement.
“The HEART Pathway is a decision aid, not a substitute for clinical judgment,” Mahler concluded in the statement. “But we do have evidence that its use can both improve evaluation and reduce unnecessary testing, hospitalization and expense.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.