Impact of coronary risk scores on disposition decision in emergency patients with chest pain

Tzu-Yun Liu; Ming-Ta Tsai; Fu-Cheng Chen; Hsiu-Yung Pan; Jyun-Bin Huang; Fu-Jen Cheng; Chi-Yung Cheng

doi:10.1016/j.ajem.2021.04.029

Impact of coronary risk scores on disposition decision in emergency patients with chest pain

Am J Emerg Med. 2021 Oct:48:165-169. doi: 10.1016/j.ajem.2021.04.029. Epub 2021 Apr 14.

Authors

Tzu-Yun Liu¹, Ming-Ta Tsai¹, Fu-Cheng Chen¹, Hsiu-Yung Pan¹, Jyun-Bin Huang¹, Fu-Jen Cheng¹, Chi-Yung Cheng²

Affiliations

¹ Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address: qzsecawsxd@cgmh.org.tw.

PMID: 33957340
DOI: 10.1016/j.ajem.2021.04.029

Abstract

Background: Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain.

Objective: This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED.

Methods: This retrospective cohort study included 3660 adult patients who presented to the ED with chest pain between January and July in 2019. Study inclusion criteria were age > 18 years and a primary position International Statistical Classification of Diseases and Related Health Problems-10th revision coded diagnosis of angina pectoris (I20.0-I20.9) or chronic ischemic heart disease (I25.0-I25.9) by the treating ED physician. If the treating ED physician completed the electronic structured variables for CRS calculation to assist disposition planning, then the patient would be classified as the CRS group; otherwise, the patient was included in the control group.

Results: Among the 2676 patients, 746 were classified into the CRS group, whereas the other 1930 were classified into the control group. There was no significant difference in sex, age, initial vital signs, and ED length of stay between the two groups. The coronary risk factors were similar between the two groups, except for a higher incidence of smokers in the CRS group (19.6% vs. 16.1%, p = 0.031). Compared with the control group, significantly more patients were discharged (70.1% vs. 64.6%) directly from the ED, while fewer patients who were hospitalized (25.9% vs. 29.7%) or against-advise discharge (AAD) (2.6% vs. 4.0%) in the CRS group. Major adverse cardiac events and mortality at 60 days between the two groups were not significantly different.

Conclusions: A higher ED discharge rate of the group using CRS may indicate that ED physicians have more confidence in discharging low-risk patients based on CRS.

Keywords: Chest pain; Coronary risk scores; Disposition; EDACS; Emergency department; HEART score.

MeSH terms

Acute Coronary Syndrome / complications
Acute Coronary Syndrome / diagnosis*
Age Factors
Aged
Angina Pectoris / complications
Angina Pectoris / diagnosis*
Chest Pain / blood
Chest Pain / epidemiology
Chest Pain / etiology
Chest Pain / physiopathology*
Clinical Decision-Making*
Cohort Studies
Coronary Artery Disease / epidemiology
Electrocardiography
Emergency Service, Hospital*
Female
Heart Disease Risk Factors
Hospitalization / statistics & numerical data*
Humans
Male
Middle Aged
Myocardial Ischemia / complications
Myocardial Ischemia / diagnosis*
Patient Discharge / statistics & numerical data*
Patient Transfer
Retrospective Studies
Sweating
Troponin / blood

Substances

Troponin