Advertisement

Cost analysis of the History, ECG, Age, Risk factors, and initial Troponin (HEART) Pathway randomized control trial

Published:October 05, 2016DOI:https://doi.org/10.1016/j.ajem.2016.10.005

      Abstract

      Introduction

      The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported.

      Methods and Results

      We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol. For low-risk patients, the HEART Pathway recommended early discharge from the emergency department without further testing. We compared index visit cost, cost at 30 days, and cardiac-related health care cost at 30 days between the 2 treatment arms. Costs for each patient included facility and professional costs. Cost at 30 days included total inpatient and outpatient costs, including the index encounter, regardless of etiology. Cardiac-related health care cost at 30 days included the index encounter and costs adjudicated to be cardiac-related within that period.
      Two hundred seventy of the 282 patients enrolled in the trial had cost data available for analysis. There was a significant reduction in cost for the HEART Pathway group at 30 days (median cost savings of $216 per individual), which was most evident in low-risk (Thrombolysis In Myocardial Infarction score of 0-1) patients (median savings of $253 per patient) and driven primarily by lower cardiac diagnostic costs in the HEART Pathway group.

      Conclusions

      Using the HEART Pathway as a decision aid for patients with undifferentiated chest pain resulted in significant cost savings.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Owens P.L.
        • Barrett M.L.
        • Gibson T.B.
        • Andrews R.M.
        • Weinick R.M.
        • Mutter R.L.
        Emergency department care in the United States: a profile of national data sources.
        Ann Emerg Med. 2010; 56: 150-165
        • Mahler S.A.
        • Hiestand B.C.
        • Goff D.C.
        • Hoekstra J.W.
        • Miller C.D.
        Can the heart score safely reduce stress testing and cardiac imaging in patients at low-risk for major adverse cardiac events?.
        Crit Pathw Cardiol. 2011; 10: 128-133
        • Mahler S.A.
        • Riley R.F.
        • Hiestand B.C.
        • Russell G.B.
        • Hoekstra J.W.
        • Lefebvre C.W.
        • et al.
        The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.
        Circ Cardiovasc Qual Outcomes. 2015; 8: 195-203
        • Wright R.S.
        • Anderson J.L.
        • Adams C.D.
        • Bridges C.R.
        • Casey D.E.
        • Ettinger S.M.
        • et al.
        2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2011; 123: 2022-2060
        • O'Connor R.E.
        • Bossaert L.
        • Arntz H.R.
        • Brooks S.C.
        • Diercks D.
        • Feitosa-Filho G.
        • et al.
        Part 9: acute coronary syndromes: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Circulation. 2010; 122: S422-S465
        • Backus B.E.
        • Six A.J.
        • Kelder J.C.
        • Mast T.P.
        • van den Akker F.
        • Mast E.G.
        • et al.
        Chest pain in the emergency room: a multicenter validation of the heart score.
        Crit Pathw Cardiol. 2010; 9: 164-169
        • Backus B.E.
        • Six A.J.
        • Kelder J.C.
        • Bosschaert M.A.
        • Mast E.G.
        • Mosterd A.
        • et al.
        A prospective validation of the heart score for chest pain patients at the emergency department.
        Int J Cardiol. 2013; 168: 2153-2158
        • Six A.J.
        • Backus B.E.
        • Kelder J.C.
        Chest pain in the emergency room: value of the heart score.
        Neth Hear J. 2008; 16: 191-196
        • Six A.J.
        • Cullen L.
        • Backus B.E.
        • Greenslade J.
        • Parsonage W.
        • Aldous S.
        • et al.
        The heart score for the assessment of patients with chest pain in the emergency department: a multinational validation study.
        Crit Pathw Cardiol. 2013; 12: 121-126
        • Miller C.D.
        • Hwang W.
        • Hoekstra J.W.
        • Case D.
        • Lefebvre C.
        • Blumstein H.
        • et al.
        Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial.
        Ann Emerg Med. 2010; 56: 209-219.e202
        • Kontos M.C.
        • Diercks D.B.
        • Kirk J.D.
        Emergency department and office-based evaluation of patients with chest pain.
        Mayo Clin Proc. 2010; 85: 284-299
        • Miller C.D.
        • Hoekstra J.W.
        • Lefebvre C.
        • Blumstein H.
        • Hamilton C.A.
        • Harper E.N.
        • et al.
        Provider-directed imaging stress testing reduces health care expenditures in lower-risk chest pain patients presenting to the emergency department.
        Circ Cardiovasc Imaging. 2012; 5: 111-118
        • Amsterdam E.A.
        • Wenger N.K.
        • Brindis R.G.
        • Casey D.E.
        • Ganiats T.G.
        • Holmes D.R.
        • et al.
        2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 64: e139-e228