Key result
HEART-guided pathway targets low-value testing after baseline chest-pain review reveals 0% MACE despite high utilization.
Why the study?
Most patients admitted for chest pain rule-out for ACS undergo low-value inpatient testing that prolongs stay and consume scarce hospital resources, with misaligned utilization relative to HEART score risk.
Does a HEART Score-Guided Accelerated Discharge Protocol reduce low-value testing and costs in patients admitted with chest pain?
Observational (n=156)
Does a HEART Score-Guided Accelerated Discharge Protocol reduce low-value testing and costs in patients admitted with chest pain?
A HEART score-guided accelerated discharge pathway for chest pain can safely reduce low-value testing and save approximately $1,000 per patient.
Hypothesis-generating for HEART-guided discharge to curb low-value testing; prospective validation required before routine adoption.
BACKGROUND: Most patients admitted for chest pain rule-out for acute coronary syndrome yet undergo low-value inpatient testing that prolongs stay and consumes scarce community-hospital resources. PROJECT RATIONALE: Baseline review showed utilization misaligned with HEART (History, Electrocardiogram, Age, Risk factors, Troponin)-derived risk and inconsistent, upwardly inflated score documentation, indicating the need for a standardized discharge pathway. PROJECT SUMMARY: Among 156 emergency department chest-pain encounters (0% 6-week major adverse cardiac events), 89% received cardiology consultation and 45% echocardiography (88% normal); 44% of documented HEART scores were inflated. We adopted the HEART Score-Guided Accelerated Discharge Protocol: mandatory same-admission cardiology consult, indication-only echocardiography, no reflexive labs, target discharge under 24 hours, and guaranteed follow-up, with prespecified measures and an approximate cost avoidance of $120,000 (about $1,000 per patient) per rule-out cohort. TAKE-HOME MESSAGE: A simple, electronic medical record-free HEART-guided pathway can safely reduce low-value testing and redirect scarce resources to higher-acuity patients.
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Khan et al. (2026) conducted an observational in Chest pain (n=156). HEART Score-Guided Accelerated Discharge Protocol was evaluated on 6-week major adverse cardiac events. Baseline review of 156 chest-pain encounters showed 0% 6-week major adverse cardiac events despite high testing utilization, leading to the adoption of a HEART-guided pathway to reduce low-value testing.
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