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.
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Article Info
Publication History
Published online: October 05, 2016
Accepted:
October 1,
2016
Received:
September 12,
2016
Footnotes
☆Clinical trial registration: clinicaltrials.gov (clinical trial number, NCT01665521).
☆☆Funding source: This study was funded by the American Heart Association Clinical Research Program. The American Heart Association had no role in the design, analysis, interpretation, or writing of this report. The corresponding author had complete access to all study data and final responsibility for article submission. Use of Research Electronic Data Capture was supported by the Wake Forest Translational Science Institute via a grant from National Center for Catalysis Research ( M01 RR007122 ).
★None of the authors have any disclosures to report.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
