Chest Pain, Coronary Artery Disease, Heart Attack
Conditions
Brief summary
This was a prospective randomized, controlled trial designed to quantify the reduction in cost and length of stay of early discharge of emergency department patients evaluated for acute myocardial infarction, who are deemed to be low risk based on a modified HEART score (a score that incorporates troponin biomarker, ecg, patient characteristics, and physician clinical judgment).
Detailed description
This was a prospective randomized, controlled trial conducted from February 2014 to May 2015 designed to quantify the reduction in cost and length of stay of early discharge of emergency department patients evaluated for acute myocardial infarction, in those deemed to be low risk based on a modified HEART score. Our study enrolled only those deemed low risk, as these are the patients we believe best served by utilization of the HEART score decision aid. A total of 105 patients evaluated for AMI in the ED with a modified HEART score ≤ 3 (which includes cardiac troponin I \< 0.04 ng/ml at 0 and 3 hours) were randomized to immediate discharge (n = 53) vs management in an observation unit with stress testing (n = 52). The primary endpoints were 30-day total cost and length of stay. Secondary endpoints were all-cause death, nonfatal AMI, rehospitalization for evaluation of possible AMI, and coronary revascularization at 30 days. That such an early discharge strategy would decrease cost and length of stay is intuitively expected; our goal was to quantify such a reduction.
Interventions
OTHERDeferral of admission for stress test
Early discharge; admission and stress test are deferred.
Sponsors
Henry Ford Health System
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* patients 21 years or older * patients who presented to the Emergency Department with symptoms suspicious for AMI. * patients for whom the ED physician's intention to send the patient to the observation unit for stress testing
Exclusion criteria
* Cardiac Troponin I \> 0.04 ng/mL at 0 or 3 hours * clinical presentation warranting admission * inability or unwillingness to consent * trauma as etiology of presenting symptoms.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cost of hospitalization | 30 days | Total charges accrued during index hospitalization, as well as costs related to index hospitalization up to 30 days after index discharge |
| Length of stay | up to 1 week | Total length of stay of index hospitalization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 30-day MACE | 30 days after index hospitalization | Death, non-fatal myocardial infarction, stroke |
Outcome results
None listed