Henry Ford HEART Score Randomized Trial: Rapid Discharge of Patients Evaluated for Possible Myocardial Infarction
Frisoli TM, Nowak R, Evans KL, Harrison M, Alani M, Varghese S, Rahman M, Noll S, Flannery KR, Michaels A, Tabaku M, Jacobsen G, McCord J. Henry Ford HEART score randomized trial: Rapid discharge of patients evaluated for possible myocardial infarction. Circ Cardiovasc Qual Outcomes. 2017 Oct;10(10). pii: e003617.
Circ Cardiovasc Qual Outcomes
BACKGROUND: Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications.
METHOD AND RESULTS: A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I
CONCLUSIONS: Among patients evaluated for possible AMI in the emergency department with a modified HEART score ≤3, early discharge without stress testing as compared with transfer to an observation unit for stress testing was associated with significant reductions in length of stay and total charges, a finding that has tremendous potential national healthcare expenditure implications.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03058120.
Medical Subject Headings
Adult; Age Factors; Aged; Angina Pectoris; Biomarkers; Cause of Death; Cost Savings; Cost-Benefit Analysis; Decision Support Techniques; Electrocardiography; Emergency Service, Hospital; Female; Hospital Costs; Hospitals, University; Humans; Length of Stay; Male; Michigan; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Patient Discharge; Patient Readmission; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Triage; Troponin I