Abstract 14785: HEART Score Utilization - Revisited

Abstract

Introduction/Background: Chest pain accounts for approximately 7.6 million visits a year to the Emergency Department (ED) in the US. With use of the HEART score, a validated instrument helps to risk stratify patients with chest pain into low, medium, and high-risk groups. Low risk patients have a 1.6% chance of experiencing a major adverse cardiac event (MACE) within 30 days and are safe discharges from the ED without further testing. Hypothesis: We hypothesize that a targeted intervention to educate providers to use the HEART score will lead to decreased testing of low-risk patients without increase in MACE. Methods: Targeted interventions: (1) we provided teaching sessions on how to use the HEART score and (2) HEART score template was embedded into admitting notes on the unit EMR. Via retrospective chart review, investigators calculated a HEART score for patients who presented with chest pain and were admitted to LUMC. We calculated the rate of further cardiac testing and length of stay (LOS) for each risk stratified group, before and after our intervention. Chi-square tests are used to evaluate for association. Results/Data: Pre-intervention (n=259), only 30.5% patients had a documented HEART score. 46.7% were low risk, of which 30.5% underwent inpatient stress test or further cardiac testing. Low-risk patients that underwent further workup had increased LOS (p=0.0048). Post intervention (n=79), 58.1% patients had a documented HEART score, a statistically significant increase (p<0.001). Of those considered low risk, fewer had further cardiac testing ordered (p<0.001). No patient with a low-risk HEART score experienced a MACE within 30 days. Conclusions: Provider education is an effective method to increase HEART score utilization and reduce inpatient cardiac testing of low-risk patients with chest pain. Our study demonstrated an increase in documentation of the HEART score and a reduction of further testing of low-risk patient groups without worse outcomes.