Original StudyImpact of HEART Score Decision Aid on Coronary Computed Tomography Angiography Utilization and Diagnostic Yield in the Emergency DepartmentMcMahon, Brian J MD; Shrestha, Pragati MPH; Thode, Henry C Jr. PhD; Morley, Eric J. MD; Rao, Ballakur; Tawfik, George-Abraam; Adhiyaman, Akshitha; Devitt, Catherine; Godbole, Nisha; Pizzuti, Joseph; Shah, Kunal; Willems, Bernardus; McKenna, Peter MD; Singer, Adam J MD Author Information Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794. Critical Pathways in Cardiology ():10.1097/HPC.0000000000000318, March 14, 2023. | DOI: 10.1097/HPC.0000000000000318 Buy PAP Metrics Abstract Objective: Emergency physicians are challenged to efficiently and reliably risk stratify patients presenting with chest pain to optimize diagnostic testing and avoid unnecessary hospital admissions. The objective of our study was to evaluate the impact of a HEART score-based decision aid (HSDA) integrated in the electronic health record (EHR) on coronary computed tomography angiography (CCTA) utilization and diagnostic yield in adult Emergency Department (ED) chest pain (CP) patients with suspected Acute Coronary Syndrome (ACS). Methods: We conducted a before and after study to determine if implementation of a mandatory computerized HSDA would reduce CCTA utilization in ED CP patients and improve the diagnostic yield of obstructive CAD (>50%). We included all adult ED CP patients with suspected ACS during the first six months of 2018 (before) and 2020 (after) at a large academic center. CCTA utilization and obstructive CAD yield were compared in patients before and after implementing the HSDA using Chi square tests. Secondarily, we assessed the association of HEART scores and CCTA results. Results: Of 3095 CP patients during the before study period, 733 underwent CCTA. Of 2692 CP patients during the after study period, 339 underwent CCTA. CCTA utilization before and after HSDA was 23.4% (95% CI 22.2-25.2) and 12.6% (95% CI 11.4-13.0), respectively; mean difference 11.1% (95%CI 0.9-13.0). Among 1072 patients undergoing CCTA, mean (SD) age and percent females before vs. after HSDA were 54 (11) vs. 56 (11) years and 50% vs. 49% respectively. We included 1014 patients (686 -before and 328 -after) for the yield analysis. Obstructive CAD was present in 15% (95% CI 12.7-17.9) and 20.1% (95%CI 16.1-24.7) before and after HSDA respectively; mean difference 4.9% (95%CI 0.1-10.1). Conclusions: Implementation of a mandatory EHR HSDA aid reduced ED CCTA utilization by half and improved diagnostic yield. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
