Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain

• Published in: The American journal of emergency medicine 2017-01, Vol.35 (1), p.132-135
• Main Authors: Wu, W. Kelly, Yiadom, Maame Yaa A.B., Collins, Sean P., Self, Wesley H., Monahan, Ken
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute coronary syndromes; Age Factors; Aged; Cardiologists; Cardiology; Cardiovascular disease; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Cohort Studies; Coronary Artery Disease - blood; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Cross-Sectional Studies; Data collection; Data dictionaries; Decision making; Decision Support Techniques; Documentation; Electrocardiography; Emergency medical care; Emergency Medicine; Emergency Service, Hospital; Female; Heart; Humans; Male; Medical records; Middle Aged; Observer Variation; Pain; Patients; Physicians; Referral and Consultation; Retrospective Studies; Risk Assessment; Triage; Troponin - blood
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.09.058

A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores. We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist. Separate ED and cardiology HEART scores were computed based on documentation by the respective physicians. Discrepancies in HEART score between ED physicians and cardiologists were quantified using Cohen κ coefficient. Thirty-three patients underwent concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, −0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were classified as high risk by the ED physician, but low risk by the cardiologist. There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.