Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial
| Autor: | Bernard J.W.M. Rensing, Hendrik Koffijberg, Roland R.J. van Kimmenade, Ghizelda R. Lagerweij, Rolf F. Veldkamp, Maarten J. Cramer, Madelon van den Heuvel, Johannes B. Reitsma, A. Jacob Six, Judith M. Poldervaart, Barbra E. Backus, Nicolette M.S.K.J. Ernst, Clara E.E. van Ofwegen-Hanekamp, Arno W. Hoes, Herman F.J. Mannaerts, Ineke M.C. Dekker, Mohamed el Farissi, Pieter A. Doevendans, Marcel A.J. Landman, Jan Melle van Dantzig, Jeroen J.J. Bucx, Yolande Appelman, Maarten W. J. van Hessen, Monique E. ten Haaf, Frank R. den Hartog, Luc Cozijnsen, Thomas Oosterhof, Eugene M. Buijs |
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| Přispěvatelé: | Health Technology & Services Research, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Chest Pain Cost-Benefit Analysis Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Coronary Disease 030204 cardiovascular system & hematology Chest pain Risk Assessment law.invention 03 medical and health sciences Electrocardiography 0302 clinical medicine Quality of life (healthcare) Randomized controlled trial law Risk Factors Health care Internal Medicine medicine Journal Article Humans 030212 general & internal medicine Cluster randomised controlled trial Prospective Studies Prospective cohort study Medical History Taking business.industry Incidence (epidemiology) Age Factors General Medicine Emergency department Middle Aged Troponin Emergency medicine Randomized Controlled Trial Female medicine.symptom Health Expenditures business Emergency Service Hospital |
| Zdroj: | Poldervaart, J M, Reitsma, J B, Backus, B E, Koffijberg, H, Veldkamp, R F, Ten Haaf, M E, Appelman, Y, Mannaerts, H F J, Van Dantzig, J M, Van Den Heuvel, M, El Farissi, M, Rensing, B J W M, Ernst, N M S K J, Dekker, I M C, Den Hartog, F R, Oosterhof, T, Lagerweij, G R, Buijs, E M, Van Hessen, M W J, Landman, M A J, Van Kimmenade, R R J, Cozijnsen, L, Bucx, J J J, Van Ofwegen-Hanekamp, C E E, Cramer, M J, Six, A J, Doevendans, P A & Hoes, A W 2017, ' Effect of using the HEART score in patients with chest pain in the emergency department : A Stepped-wedge, cluster randomized trial ', Annals of Internal Medicine, vol. 166, no. 10, pp. 689-697 . https://doi.org/10.7326/M16-1600 Annals of Internal Medicine, 166(10), 689. American College of Physicians Annals of Internal Medicine, 166(10), 689-697. American College of Physicians Annals of Internal Medicine C.2, 166, 689-697 Annals of Internal Medicine C.2, 166, 10, pp. 689-697 |
| ISSN: | 0003-4819 |
| DOI: | 10.7326/M16-1600 |
| Popis: | Item does not contain fulltext Background: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown. Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources. Design: Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT01756846). Setting: Emergency departments in 9 Dutch hospitals. Patients: Unselected patients with chest pain presenting at emergency departments in 2013 and 2014. Intervention: All hospitals started with usual care. Every 6 weeks, 1 hospital was randomly assigned to switch to "HEART care," during which physicians calculated the HEART score to guide patient management. Measurements: For safety, a noninferiority margin of a 3.0% absolute increase in MACEs within 6 weeks was set. Other outcomes included use of health care resources, quality of life, and cost-effectiveness. Results: A total of 3648 patients were included (1827 receiving usual care and 1821 receiving HEART care). Six-week incidence of MACEs during HEART care was 1.3% lower than during usual care (upper limit of the 1-sided 95% CI, 2.1% [within the noninferiority margin of 3.0%]). In low-risk patients, incidence of MACEs was 2.0% (95% CI, 1.2% to 3.3%). No statistically significant differences in early discharge, readmissions, recurrent emergency department visits, outpatient visits, or visits to general practitioners were observed. Limitation: Physicians were hesitant to refrain from admission and diagnostic tests in patients classified as low risk by the HEART score. Conclusion: Using the HEART score during initial assessment of patients with chest pain is safe, but the effect on health care resources is limited, possibly due to nonadherence to management recommendations. Primary Funding Source: Netherlands Organisation for Health Research and Development. |
| Databáze: | OpenAIRE |
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