The following is a summary of “Differences in cardiac testing resource utilization using two different risk stratification schemes,” published in the March 2023 issue of Emergency Medicine by Tyner, et al.

For a study, researchers sought to determine if changing the chest pain pathway in the emergency department (ED) from using the Thrombolysis in Myocardial Infarction (TIMI) score to the History, EKG, Age, Risk, Troponin (HEART) score was associated with decreased healthcare resource utilization. 

A retrospective, quasi-experimental study used difference-in-differences and interrupted time series specifications. The study included all ED patients with chest pain encounters from 8/2015 to 7/2019 at a large academic medical center aged≥ 18 and had negative troponin testing discharged from the ED. The standardized care pathway used TIMI for risk stratification until 09/2017 and HEART afterward. The study evaluated patients undergoing hospital-based cardiac diagnostic testing (CDT), length of stay (LOS), and 30-day Major Adverse Cardiovascular Events (MACE) at the intervention site before and after the pathway change and compared these outcomes to a similar control site within the health system for the difference-in-differences specification.

Results showed that during the study period, 6.3% (450 of 7,117) of patients in the TIMI cohort and 7.2% (546 of 7,623) in the HEART cohort among 400,965 total ED visits underwent CDT. A multivariable analysis revealed that transitioning to the HEART pathway was associated with greater odds of receiving CDT (odds ratio 2.88 [95% CI 1.21 to 6.86]), a reduction in LOS of 34 min (95% CI 2.2 to 67.6), and no significant difference in 30-day MACE.

In conclusion, transitioning from TIMI to HEART had mixed consequences for healthcare resource utilization. Although there was an increase in CDT, there was also a reduction in LOS.

Reference: sciencedirect.com/science/article/pii/S0735675722007653