There is a low rate of major adverse cardiovascular events in chest pain patients with a moderate risk heart score referred from urgent care for expedited outpatient cardiology evaluation: a multi-center study
https://doi.org/10.17802/2306-1278-2021-10-1-50-54
Аннотация
Background. The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The rate of major adverse cardiovascular events (MACE) in patients with moderate HEART score referred from an urgent care (UC) for an expedited outpatient cardiology evaluation for 11 months was described in 133 patients in a previous study. This is a follow-up study with 18 months of data and 206 patients.
Aim. The primary outcome was to examine the rate of MACE when patients with moderate HEART score were referred for an expedited outpatient cardiology follow-up after evaluation in urgent care. The secondary outcome was to determine if there is a decrease in rate of ED transfer after this protocol was introduced.
Methods. A cross-sectional study was conducted by a multispecialty group in Las Vegas, Nevada, which included 206 patients with a HEART score of 4 to 6 (i.e.: moderate risk) who presented to one of five UC centers with chest pain or an anginal equivalent. A streamlined evaluation protocol to assess each HEART score component was adopted by all UC providers to facilitate an expedited outpatient cardiology follow-up, as an alternative to referral to the emergency department. Data was collected from February 14, 2019 through August 13, 2020. The population was followed for 6 weeks with a primary endpoint of MACE determined by electronic medical record review and direct phone contact with patients. Outcomes were confirmed in 98% of patients. Chest pain transfer data was compared between 12 months prior to implementing HEART protocol and 18 months of data analysis while using the new protocol.
Results. Over the course of 18 months, 206 patients with a moderate risk HEART score were referred to outpatient cardiology in an expedited manner. The average age was 65 with 53% female and 47% male patients. 150 patients (73% of the 206) were seen within 3 days, 114 (55%) underwent stress testing, 6 (3%) had coronary computed tomography angiogram, and 6 (3%) received an invasive coronary angiogram. Five patients were found to have MACE: one patient who had a non-ST-elevation myocardial infarction and subsequent coronary stent, two patients were found to have obstructive disease after coronary angiography with subsequent coronary artery bypass graft, one patient had an abnormal stress test and subsequent coronary stent, and one patient had critical mitral stenosis, multi-vessel coronary artery disease and underwent coronary artery bypass graft with mitral valve replacement with complications of renal failure and COVID-19 and expired. The emergency department referral rate declined by 21%.
Conclusion. Patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no deaths due to delay of care. There was also a significant decrease in the rate of ED referrals.
Об авторах
S. BarbarashСоединённые Штаты Америки
Svetlana Barbarash - MD, Fellow of the American College of Cardiology, Cardiologist, Department of Cardiology, Southwest Medical, part of OptumCare.
888 S, Rancho Dr, Las Vegas, Nevada 89106.
Конфликт интересов:
S. Barbarash declares no conflict of interest related to this article.
D. Lebron-Gallagher
Соединённые Штаты Америки
Dolores Lebron-Gallagher - MS, Physician Assistant - Certified, Department of Cardiology, Southwest Medical, part of OptumCare.
888 S, Rancho Dr, Las Vegas, Nevada 89106.
Конфликт интересов:
D. Lebron-Gallagher declares no conflict of interest.
H. Julson
Соединённые Штаты Америки
Hollis Julson - MD, Department of On Demand Medicine, Southwest Medical, part of OptumCare.
888 S, Rancho Dr, Las Vegas, Nevada 89106.
PMID 18019873
Конфликт интересов:
H. Julson declares no conflict of interest.
M. B. Weinstock
Соединённые Штаты Америки
Michael B. Weinstock - MD, Director of Medical Education and Research, Adena Health System; an adjunct professor of Emergency Medicine, Department of Emergency Medicine, Wexner Medical Center at The Ohio State University.
272, Hospital Rd, Chillicothe, Ohio 45601; 410 W, 10th Ave, Columbus, Ohio 43210.
Конфликт интересов:
M.B. Weinstock declares no conflict of interest.
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13. Barbarash S., Lebron-Gallagher D., Julson W.M. A multicenter study of the rate of MACE in chest pain patients with a moderate HEART risk score referred from urgent care for an expedited outpatient cardiology evaluation. JUCM .2020; 9: 31-35. Available at: https://www.jucm.com/a-multicenter-study-of-the-rate-of-mace-in-chest-pain-patients-with-a-moderate-heart-risk-score-referred-from-urgent-care-for-an-expedited-outpatient-cardiology-evaluation/
Рецензия
Для цитирования:
Barbarash S., Lebron-Gallagher D., Julson H., Weinstock M.B. There is a low rate of major adverse cardiovascular events in chest pain patients with a moderate risk heart score referred from urgent care for expedited outpatient cardiology evaluation: a multi-center study. Комплексные проблемы сердечно-сосудистых заболеваний. 2021;10(1):50-54. https://doi.org/10.17802/2306-1278-2021-10-1-50-54
For citation:
Barbarash S., Lebron-Gallagher D., Julson H., Weinstock M.B. There is a low rate of major adverse cardiovascular events in chest pain patients with a moderate risk heart score referred from urgent care for expedited outpatient cardiology evaluation: a multi-center study. Complex Issues of Cardiovascular Diseases. 2021;10(1):50-54. https://doi.org/10.17802/2306-1278-2021-10-1-50-54