Work

Rapid outpatient evaluation for emergency department patients with intermediate risk chest pain safely reduces admissions

Year: 2024

Type: article

Abstract: Objective: This study aims to assess the safety of an outpatient chest pain pathway (OCPP) for patients presenting to the emergency department (ED) with chest pain and a HEART score of 4 or 5. Methods: This is a retrospective, observational, non-inferiority study assessing the impact of the OCPP on the management and outcomes of ED patients with HEART score of 4 or 5. The study compared patients evaluated in the pre-OCPP (January‒May 2018) and the post-OCPP period (January‒October 2022). Data were collected via non-blinded chart review. The primary outcome was the rate of acute myocardial infarction (AMI) and death in patients utilizing the OCPP compared to patients with HEART score 4 or 5 in 2018. Secondary outcomes included admission rates before and after the implementation of this pathway. Non-inferiority of the post-intervention study epoch for the AMI/death composite outcome was assessed via the two one-sided tests (TOST), procedure. Results: After implementing the OCPP, rates of patients with ED HEART score of 4 or 5 admitted from the ED decreased from 85.1% (605/711) to 74.1% (1239/1671) in 2022. Of the 432 total patients discharged in 2022, 237 (54.6%) patients were referred to emergent cardiology follow-up via the OCPP. The 30-day rate of AMI/death for patients discharged via the OCPP was 0.4% (1/237), as compared to 2.2% (8/368) in 2018. When compared to rates of AMI/death for all patients with HEART score 4 or 5 in 2018, outcomes for OCPP patients were found to be non-inferior. Conclusion: The OCPP resulted in non-inferior rates of AMI/death in patients with HEART scores of 4 or 5 as compared to usual care.

Source: Journal of the American College of Emergency Physicians Open

DOI: 10.1002/emp2.13280

Authors: Quentin Reuter, Nicholas Lesh, Michelle Reyes, David Gothard, Michael Pallaci, Michael Weinstock