Abstract 13433: Outcomes of Chest Pain Discharge Decisions Following Launch of a Heart Score Clinical Decision Support Alert

Background: The use of a bioclinical risk score such as the HEART score is recommended for the evaluation of pts presenting to the ED with chest pain (CP). Prior studies have demonstrated that CP pts with HEART score

3 and “ruled out” with cardiac troponin series are low risk for 30d death/MI (MACE). There is limited data regarding whether the addition of the HEART score to a validated high sensitivity troponin accelerated diagnostic protocol (ADP) has beneficial effects on CP patient discharge decisions in the ED.

Research Question: Did the addition of an EHR-embedded automated HEART score clinical decision support alert (CDSA) have a beneficial effect on discharge decision making of ED CP pts in Geisinger Health System?

Methods: Retrospective analysis of 30day MACE following ED visit for CP for the 6mo period prior to and 10mo following the launch of a HEART score CDSA (11/2021-3/2023). Discharges were stratified using a previously validated accelerated hsTnT ADP into those that ruled in (ADP+) or ruled out (ADP-). Comparison of MACE in pre- vs. post-CDSA periods was performed using chi square analysis.

Results: MACE stratified by study period and ADP results are summarized in the Table. There were no significant differences in 30-day MACE pre- vs. post-CDSA, both overall and in ADP+ and ADP- subgroups. In contrast, the presence or absence of a high risk (>3) HEART score in isolation did significantly predict the risk of MACE [11/2360 (0.47%) for HEART score

3 vs 36/966 (4.04%) for HEART score >3, p<0.001].

Conclusions: Addition of an EHR-embedded HEART Score CDSA did not have a significant effect on 30d outcomes following ED provider discharge decisions. While the HEART score by itself did stratify risk of 30d MACE, our study suggests the additive benefit of the HS CDSA to clinical decision making based on an established hsTnT ADP unclear.