Preview

Комплексные проблемы сердечно-сосудистых заболеваний

Расширенный поиск

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

Полный текст:

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. Barbarash
Southwest Medical, Part of OptumCare
Соединённые 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
Southwest Medical, Part of OptumCare
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
Southwest Medical, Part of OptumCare
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
Adena Health System; The Ohio State University Wexner Medical Center
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.



Список литературы

1. Six A.J., Backus B.E., Kelder J.C. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008; 16 (6): 191-6. doi: 10.1007/BF03086144

2. Backus B.E., SixA.J., Kelder J.C., Mast T.P., van denAkker F., Mast E.G., Monnink S.H., van Tooren R.M., Doevendans P.A. Chest Pain in the Emergency Room: A Multicenter Validation of the HEART Score. Crit Pathways in Cardiol 2010;9: 164-169. doi: 10.1097/HPC.0b013e3181ec36d8.

3. Backus B.E., Six A.J., Kelder J.C., Bosschaert M.A., Mast E.G., Mosterd A., Veldkamp R.F., Wardeh A.J., Tio R., Braam R., Monnink S.H., van Tooren R., Mast T.P., van den Akker F., Cramer M.J., Poldervaart J.M., Hoes A.W., Doevendans P.A. A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology 168 (2013) 2153-2158. doi: 10.1016/j.ijcard.2013.01.255.

4. Laureano-Phillips J., Robinson R.D., Aryal S., Blair S., Wilson D., Boyd K., Schrader C.D., Zenarosa N.R., Wang H. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2019;74(2):187-203. doi: 10.1016/j.annemergmed.2018.12.01

5. Tomaszewski C.A., Nestler D., Shah K.H., Sudhir A., Brown M.D. Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non-ST-Elevation Acute Coronary Syndromes. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Suspected Non-ST-Elevation Acute Coronary Syndromes. Ann Emerg Med. 2018 Nov; 72(5):e65-e106. doi: 10.1016/j.annemergmed.2018.07.045.

6. Antman E.M., Cohen M., Bernink P.J., McCabe C.H., Horacek T., Papuchis G., Mautner B., Corbalan R., Radley D., Braunwald E. The IMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000; 284(7):835-42. doi: 10.1001/jama.284.7.835.

7. Than M., Herbert M., Flaws D., Cullen L., Hess E., Hollander J.E., Diercks D., Ardagh M.W., Kline J.A., Munro Z., Jaffe A. What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the emergency department? a clinical survey. Int J Cardiol. 2013;166(3):752-754 doi: 10.1016/j.ijcard.2012.09.171.

8. Weinstock M.B., Weingart S., Orth F., VanFossen D., Kaide C., Anderson ,. Newman D.H. Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med. 2015; 175:1207-1212. doi: 10.1001/jamainternmed.2015.1674.

9. Hess E.P., Hollander J.E., Schaffer J.T., Kline J.A., Torres C.A., Diercks D.B., Jones R., Owen K.P., Meisel Z.F., Demers M., Leblanc A., Shah N.D., Inselman J., Herrin J., Castaneda-Guarderas A., Montori V.M. Shared decision making in patients with low-risk chest pain: prospective randomized pragmatic trial. BMJ. 2016;355:i6165 doi: 10.1136/bmj.i6165.

10. Hess E.P., Knoedler M.A., Shah N.D., Kline J.A., Breslin M., Branda M.E., Pencille L.J., Asplin B.R., Nestler D.M., Sadosty A.T., Stiell I.G., Ting H.H., Montori V.M. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes 2012; 5:251-9. doi: 10.1161/CIRCOUTCOMES.111.964791.

11. Dubin J., Kiechle E., Wilson M., Timbol C., Bhat R., Milzman D. Mean HEART scores for hospitalized chest pain patients are higher in more experienced providers. Am J Emerg Med. 2017;35:122-125. doi: 10.1016/j.ajem.2016.10.037.

12. Wu W.K., Yiadom M.Y., Collins S.P., Self W.H., Monahan K. Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain. Am J Emerg Med. 2017; 35:132135. doi: 10.1016/j.ajem.2016.09.058.

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/


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

Просмотров: 219


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2306-1278 (Print)
ISSN 2587-9537 (Online)