New protocol can help emergency departments evaluate patients with acute chest pain.

A recently developed risk-evaluation protocol can help hospital emergency department personnel more efficiently determine which patients with acute chest pain can be sent home safely, according to a randomized trial conducted at Wake Forest Baptist Medical Center. The study, published in the current online issue of the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, found that chest-pain patients who were evaluated with the new protocol, called the HEART Pathway, had 12 percent fewer cardiac tests, 21 percent more early discharges, and shorter hospital stays than those who received standard care. No patient identified for early discharge in either group had a major heart problem within 30 days of their emergency department visit.
The HEART Pathway is based on the widely used HEART score system, which weighs five components - the patient's history, electrocardiogram reading, age, risk factors and levels of troponin, a protein in blood released when the heart muscle is damaged - to determine an individual's risk of having a serious cardiac problem. But the HEART Pathway includes one more element: a second blood test to measure troponin levels, administered three hours after the first one.
"The HEART Pathway is a decision aid, not a substitute for clinical judgment," Doctor said, "but there is strong evidence to support that its use can both improve evaluation and reduce unnecessary testing, hospitalization and expense."