Cardiovascular-Clinical Research
Abstracts
.jpg "Iltifat Husain, MD photo")
Iltifat Husain, MD
Wake Forest School of Medicine
Disclosure Relationship(s): Impathiq: Stock Shareholder (excluding mutual funds)
Paul Musey, Jr., MD, MSc
Indiana University School of Medicine
Background: The History, ECG, Age, Risk factors, and Troponin (HEART) Pathway is a validated tool designed to identify Emergency Department (ED) patients with chest pain for early discharge. However, data evaluating the impact of the HEART Pathway on Observation Unit (OU) use is limited. The objective of this study is to determine whether the HEART Pathway decreases OU use and whether the patients placed in the OU are higher risk.
Methods: A retrospective analysis of OU registry data from 2 years before (10/2012-11/2014) and after (11/2014-10/2016) HEART Pathway implementation at an academic medical center was conducted. All adult ED patients placed in the OU chest pain protocol for provocative testing or computerized tomography (CT) coronary angiography were included in this analysis. The proportion of patients placed in the OU chest pain protocol per total OU volume, the hospital admission rate, and the myocardial infarction (MI) rate was determined from health records. Proportions were compared using Chi-Squared Tests. The patient populations in the OU before and after HEART Pathway implementation were compared for age using a Mann-Whitney U Test.
Results: During the study period, a total of 3,379 patients were included; 1,687 before and 1,692 after HEART Pathway implementation. The proportion of chest pain patients in the OU per total OU volume decreased pre- and post-implementation with 57% (1,687/2968) and 39% (1,692/4,355) respectively (p<0.001). Before HEART Pathway implementation the admission rate was 10.4% (175/1687) versus 12.4% (210/1692) after implementation (p=0.07). Age and MI status were available on 3,351 patients. More patients were diagnosed with MI following implementation; with 0.8% (14/1,665) with MI pre-implementation compared to 2.0% (33/1686) post-implementation (p=0.008). Likewise, OU patients were younger pre-implementation with a median age of 52 years (IQR: 45-59 years) vs 54 years (IQR: 48-64 years) post-implementation; p<0.001.
Conclusion: HEART Pathway implementation significantly reduced the use of the observation unit for acute chest pain. However, following HEART Pathway implementation OU chest pain patients were older and more likely to be diagnosed with MI. These findings suggest Heart Pathway implementation may result in improved diagnostic yield in the OU.