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. 2019 Oct;31(10):610-614.
doi: 10.1097/JXX.0000000000000194.

Retrospective analysis of HEART Score results in cost saving

Sandra A Arnold  1 , Cathy Grant  2 , Kathy Magdic  2 , Gavin W Hickey  3 , Mary Beth Tedesco  1
Affiliations

Retrospective analysis of HEART Score results in cost saving

Sandra A Arnold et al. J Am Assoc Nurse Pract. 2019 Oct.

Abstract

Background and purpose: Chest pain (CP) is one of the most frequent chief complaints of patients presenting to the emergency department (ED). Diagnoses range from life-threatening acute coronary syndrome (ACS) to less concerning musculoskeletal injury. Patients are frequently admitted for comprehensive cardiac evaluation. However, it is estimated that <10% are diagnosed with ACS. Identifying low-risk patients who can be safely discharged from the ED results in lower cost burden and less patient days. The HEART Score is a recently validated tool for undifferentiated CP in the ED used to identify low-risk patients. The purpose of this project was to ascertain if the HEART Score could be utilized in the Veteran population for the evaluation of undifferentiated chest pain.

Local problem: There is no standard assessment tool used in the ED at the Veterans Administration Pittsburgh Healthcare System (VAPHS) to evaluate CP in low-risk patents.

Methods: As part of a quality improvement initiative, a retrospective analysis was performed on patients presenting to the ED with CP over a 6-month period. A total of 197 VAPHS patients were identified through the computerized medical record system. HEART Scores were calculated for each patient. Patients scored as low risk (score of 0-3) were further evaluated for major adverse cardiac events (MACE) and cost saving.

Conclusions: Approximately 28% (56) of the patients presenting to the ED with CP were at low risk based on the HEART Score. There were no MACE. There were cost savings compared with usual care ($1,145 vs. $4,700).

Implications for practice: The HEART Score can be safely used to identify low-risk patients and result in cost savings for Veteran population.

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Comment in

  • Millstones and milestones.
    Curry K. Curry K. J Am Assoc Nurse Pract. 2019 Oct;31(10):549-550. doi: 10.1097/JXX.0000000000000347. J Am Assoc Nurse Pract. 2019. PMID: 31592869 No abstract available.

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