HEART Score (HS) is a risk stratification tool used in predicting major adverse cardiac events (MACE) in patients presenting with undifferentiated chest pain. It is calculated by attributing zero, one, or two points in the following domains: history, EKG, age, risk factors, and troponin with a composite score of zero to ten. Low-risk patients with HS ≤3 are considered safe for outpatient evaluation. Prior studies show appropriate utilization of the HS reduces hospitalizations and unnecessary cardiac testing as well as healthcare cost. We conducted a retrospective chart review of young adults <45 years of age, admitted from the emergency department (ED) with undifferentiated chest pain between August 2018 and September 2019. HS was calculated for each adult, and when available, compared to scores calculated by the ED. Patients were reviewed for 30 day MACE, HS accuracy, diagnostic testing, and hospitalization cost. Of our 150 admitted patients, 91 (60.7%) had a HS ≤3 representing a low-risk cohort. HS was calculated by the ED in 36 patients (24%), 11 of those 36 were low-risk. 23 out of 36 patients had scores different from our calculation. No MACE occurred in the low-risk group. A single angioplasty was performed in a patient with a HS of 5. Median charge on each admitted patient with HS ≤3 is $19,000, translating to 1.73 million dollars.In a rural community hospital, outpatient management of young adults age ≤45 with a HS≤3 appears safe and cost-effective. In our institution, the HS was underused with score variability among providers. We feel there is an opportunity to improve care and save money through proper implementation of the HS. This is achievable through education, standard protocols, and better communication among ED, in-patient, and ambulatory services.
Osteoporosis awareness among patients in Singapore (OASIS)—a community hospital perspective
