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The following is a summary of “Effect of a HEART Score Best Practice Alert on Discharge Decisions and Outcomes of Patients Presenting to an Emergency Department with Chest Pain,” published in the November 2024 issue of Emergency Medicine by Vaskas et al. 

The use of a high-sensitivity troponin (hsTn) accelerated decision protocol (ADP) for chest pain (CP) was evaluated, but the benefit of adding a bioclinical risk score like the HEART score remained uncertain.  

Researchers conducted a retrospective study to evaluate the effect of an automated best practice alert (BPA), guiding HEART score capture on emergency department (ED) discharge decisions and patient outcomes, when integrated with a high-sensitivity troponin assay.  

They reviewed data of individuals assessed for CP over 6 months before and a 10-month period after the introduction of a HEART score BPA in May 2022. Discharge percentages and 30-day major adverse cardiac event (MACE) rates were analyzed for pre-and post-BPA cohorts. Data was stratified by peak hsTnT levels and HEART scores.  

The results showed post-BPA implementation, patients with a completed HEART score had a significantly higher ED discharge rate than the pre-BPA cohort (5.5% vs 3.6%, P <0.001). Additionally, patients with low-risk HEART scores (≤3) had significantly lower 30-day MACE rates (1.6% vs 0.6%, P =0.001), while those with high-risk scores had substantially higher rates (1.6% vs 6.6%, p<0.001) compared to the pre-BPA period. The HEART score demonstrated the strongest association with MACE in patients with a peak hsTnT level of 12-51 ng/dL (3.9% vs 6.7%, P <0.028).  

Investigators concluded the integration of a HEART score BPA with a hsTnT ADP enhanced ED discharge decision-making and risk stratification for 30-day MACE, especially in patients with moderate troponin elevations. 

Source: jem-journal.com/article/S0736-4679(24)00375-5/fulltext