Alex Chen, MD
Combining a Δ1h high-sensitivity troponin (hsTn) with the HEART score in a diagnostic algorithm helped decrease admission rates (59% to 33%) and median health-care costs ($1,748 to $1,079) with no significant difference in clinical outcomes. It is important to realize that this study was not randomized and was underpowered to detect differences in clinical outcome.
Why does this matter?
Chest pain is a high-risk chief complaint that we deal with every day. We have had some major developments in the evaluation of chest pain and this is the first study to look at a diagnostic algorithm for Δ1h hsTn plus HEART score.
What’s the quickest way to your HEART?
This was a prospective observational multicenter study performed at 6 centers in Sweden. It was performed in two phases where they implemented the diagnostic pathway in the second phase. This study was not randomized and the recruitment was limited by the availability of a research assistant (only available Monday - Friday during office hours). This led to potentially missing out on patients who presented late at night/early morning or on weekends. Primary outcome was hospital admission rate. Secondary outcomes included time to discharge, health-care related costs, and clinical outcomes (return to the ED, MI, unplanned revascularization, and death). However, it was not powered to detect differences in clinical outcomes. This protocol drastically reduced admission rate, cost, and hospital length of stay (23 hours to 5 hours). Ultimately, this study is more geared towards decreasing the admission rate of these patients and the vast amount of resources that we dedicate to this chief complaint. While this doesn’t tell me much about clinical outcomes of these patients, this algorithm should theoretically give me more confidence in identifying the super low-risk patients.
A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions. Ann Emerg Med. 2019 May;73(5):491-499. doi: 10.1016/j.annemergmed.2018.11.039. Epub 2019 Jan 17.
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Reviewed by Thomas Davis