Early Emergency Department Discharge for Intermediate HEART Score Patients Presenting for Chest Pain
Authors: Pawlikowski A, Hubbard E, Krauss J, Valle J, Doan J, DeMeester S, Hubbard B
Journal: Journal of the American College of Emergency Physicians Open, October 2023
Conclusions:
- Moderate-risk HEART score patients can potentially be safely discharged from the ED with plans for rapid cardiology follow-up.
- Formalizing such processes might offer a viable alternative to hospital admission without compromising patient outcomes.
Results:
- 2,939 patient encounters were screened.
- 333 out of 547 eligible moderate-risk HEART score patients were referred for rapid follow-up.
- Median time to follow-up appointment: 2.9 business days.
- 79% of patients kept their follow-up appointment.
- Outcomes: One patient (0.3%) suffered death within 30 days, before cardiology follow-up. No myocardial infarctions were reported.
Methods:
- Retrospective cohort analysis.
- Time Frame: April 2020 - December 2020.
- Participants: Patients presenting to the ED with chest pain.
- Evaluation: Serial conventional troponin testing and ECG.
- Shared decision-making with moderate-risk patients (HEART score 4-6).
- Options: Hospital admission or discharge home with rapid cardiology follow-up within 2 business days.
- Outcome Measures: Frequency of acute myocardial infarction or death at 30 days and before cardiology follow-up.
Pawlikowski A, Hubbard E, Krauss J, Valle J, Doan J, DeMeester S, Hubbard B. Early emergency department discharge for intermediate heart score patients presenting for chest pain. J Am Coll Emerg Physicians Open. 2023 Sep 9;4(5):e13037. doi: 10.1002/emp2.13037. PMID: 37692195; PMCID: PMC10492236.