Use of HEART Score in ER Can Help Evaluate Low Risk Chest Pain

MedicalResearch.com Interview with:

Judith Poldervaart MD, PhD Assistant professor Julius Center for Health Sciences and Primary Care University Medical Center  Utrecht

Dr.Poldervaart

Judith Poldervaart MD, PhD
Assistant professor
Julius Center for Health Sciences and Primary Care
University Medical Center
Utrecht

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Since its development in 2008, interest in the HEART score is increasing and several research groups around the world have been publishing on the HEART score. After validation of any risk score for cardiac events, there is a concern about the safety when used in daily practice.

We were able to show the HEART score is just as safe as the usual care currently used at EDs, which has not been shown yet in previous research. That we did not find a decrease in costs, is probably due to the hesitance of physicians to discharge low-risk patients from the ED without further testing. But extrapolation of the findings of a cost-effectiveness analysis (including nonadherence) suggests that HEART care could lead to annual savings of €40 million in the Netherlands. Hopefully, in time (and more publications of the HEART score now appearing almost weekly from all over the world) this effect on use of health care resources will become more apparent.

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Tool Can Help Avoid Overtesting in Evaluation of Chest Pain

MedicalResearch.com Interview with:

James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine

Dr. James Udelson

James E. Udelson, MD
Chief, Division of Cardiology
Director, Nuclear Cardiology Laboratory
Professor, Tufts University School of Medicine  

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation”

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Non-Cardiac Chest Pain After Acute MI Associated With Poor Quality of Life

MedicalResearch.com Interview with:

Dr. Mohammed Qintar, MD Cardiovascular Fellow St Luke’s Health System Kansas City

Dr. Mohammed Qintar

Dr. Mohammed Qintar, MD
Cardiovascular Fellow
St Luke’s Health System
Kansas City

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One in four patients experience recurrent chest pain after acute myocardial infarction, but not all patients present with cardiac chest pain secondary to coronary ischemia. The frequency of non-cardiac chest pain re-hospitalitzation after acute myocardial infarction and its impact on patients’ health status has not been described after acute myocardial infarction (AMI). Both providers evaluating these patients and patients who have recently suffered an AMI are understandably concerned about any recurrent chest pain symptoms, and often present for urgent evaluation of these symptoms.

In the first year after acute myocardial infarction, we found that a third of patients hospitalized for evaluation of chest pain actually presented with non-cardiac chest pain. Compared with patients not hospitalized with chest pain, non-cardiac chest pain hospitalization was associated with worse angina-related quality of life and general mental and physical health status. The quality of life for patients hospitalized with non-cardiac chest pain was similar to patients hospitalized with cardiac chest pain, suggesting a significant impact on their quality of life even though their pain did not reflect underlying coronary ischemia.

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Chest Pain in the Emergency Room: Clinical Decision Strategy

Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UKMedicalResearch.com Interview with: 
Dr. Richard Body
Emergency Department
Manchester Royal Infirmary
Manchester UK

 

MedicalResearch.com: What are the main findings of the study?

Dr. Body: This paper actually reports the findings of two consecutive, separate studies.  We aimed to derive and then externally validate a clinical decision rule to risk stratify patients with suspected acute coronary syndromes in the Emergency Department (ED).  This rule could then be used to reduce unnecessary hospital admissions while also making judicious use of specialist high dependency resources.

In the first study we derived a clinical decision rule that incorporates 8 variables: high sensitivity troponin T, heart-type fatty acid binding protein; ECG ischaemia; worsening angina; hypotension (systolic blood pressure <100mmHg on arrival); sweating observed in the ED; pain associated with vomiting; and pain radiating to the right arm or shoulder.  When we validated the rule at a different centre, we found that its use could have avoided hospital admission for over a quarter of patients while effectively risk stratifying others.  Of the 10% of patients who were identified as ‘high risk’, approximately 95% had a major adverse cardiac event within 30 days.  The findings suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule could be used to ‘rule in’ and ‘rule out’ acute coronary syndromes immediately, using information gathered at the time of initial presentation to the ED.  Before clinical implementation, we recommend that effect of using the MACS rule in practice should first be evaluated in a trial setting.  This will enable us to determine:
(a) whether physicians and patients are likely to comply with (and be satisfied with) the MACS rule;
(b) the safety of the MACS rule when used in practice; and
(c) whether use of the MACS rule leads to cost savings for the health service.

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Pediatric Cardiology Chest Pain Guideline Validation

David R. Fulton, M.D. Associate Cardiologist-in-Chief for Administration Tommy Kaplan Chair in Cardiovascular Studies Chief, Cardiology Outpatient Services Department of Cardiology Children's Hospital Boston Boston, MA 02115David R. Fulton, M.D.
Associate Cardiologist-in-Chief for Administration
Tommy Kaplan Chair in Cardiovascular Studies
Chief, Cardiology Outpatient Services
Department of Cardiology
Children’s Hospital Boston
Boston, MA 02115

MedicalResearch.com:   What are the main findings of this study?

Dr. Fulton: The main findings of this study demonstrated that using a quality improvement methodology (SCAMPs), a diverse population of children and adolescents with chest pain could be managed  with relative uniformity and cost effectiveness in a multi-center collaborative.  Only 2 patients of the 1016 children who formed the basis for this review were shown to have a cardiac etiology.   The clinicians were able to screen and reach a diagnostic conclusion in a  large segment of this population using history, physical examination and ECG.
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