Coronary Artery Disease Clinical Trial
Official title:
Henry Ford Heart Score Randomized Trial: Rapid Discharge of Patients Evaluated for Possible Myocardial Infarction
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).
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.
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