Chest pain patients with intermediate risk HEART score are safe for an expedited outpatient cardiology evaluation - a multicenter study

Introduction The HEART score is an effective method of risk-stratifying ED* patients with chest pain. Patients with moderate risk of MACE* are often admitted for an in-patient evaluation. The rate of MACE in patients with moderate risk HEART score referred from a free-standing UC* for an expedited outpatient cardiology evaluation is unknown. This is a follow up on previously published data on 446 patients by these authors. Purpose The primary outcome was to examine the rate of MACE when patients with a moderate-risk HEART core were referred for an expedited outpatient cardiology follow-up after evaluation in UC. Method A retrospective cross-sectional study was performed on 800 patients who presented to one of five UC centers with chest pain or anginal equivalent and a HEART score of 4 to 6 (moderate risk) in a city, Nevada. A streamlined disposition protocol for patients with a moderate risk HEART score was adopted by all UC providers to facilitate an outpatient cardiology follow-up within 3 days as an alternative to referral to the ED. Data was collected from 2/14/2019 through 3/31/2024. The population was followed for 6 weeks with a primary endpoint of MACE (death, MI, revascularization) determined by electronic medical records review and direct phone contact with patients. Results 800 patients with a moderate risk HEART score were referred to outpatient cardiology. The average age was 66 years with 56% female; 58% had HEART score of 4, 30% score of 5, 12% score of 6. Of the total, 39% had known coronary artery or peripheral vascular disease, 76% had hypertension, 34% diabetes mellitus, 87% dyslipidemia, 24% morbid obesity and 11% were smokers. In follow up, 750 patients (93.7%) were seen by a cardiology provider with 634 patients (84.5%) being seen within 3 days. Of the patients who were seen, 406 stress tests were ordered (54.1%) with 352 completed. 160 CCTA* were ordered (21.3%) with 116 completed. 28 invasive coronary angiograms were ordered (3.7%) with 19 completed. Outcomes were confirmed in 95.5% of referred patients. A total of 14 patients (1.75%) were found to have MACE including 5 with MI* (0.6%) and 1 with death from an unknown cause (0.1%). Conclusion Patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no confirmed deaths due to delay in care.