New Criteria Reduce Admissions and Heart Stress Tests at Pasadena-based Kaiser

Saturday, March 2, 2019 | 3:13 am

Emergency physicians at Pasadena-based Kaiser Permanente have reduced hospital admissions and cardiac stress testing through the application new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events.

The new assessment implemented across Kaiser Permanente Southern California improved the quality and efficiency of care for these patients, according to an article published Feb. 27 in “Annals of Emergency Medicine,” a Kaiser Permanente statement said.

“By assessing patients who come into the emergency department using HEART – a measure of history, electrocardiogram (ECG), age, risk factors and troponin, a blood test that measures heart injury – we were able to avoid unnecessary hospitalizations and cardiac testing for many patients without increasing their risk of heart damage,” said Dr. Adam Sharp, Kaiser emergency physician and researcher with the healthcare provider’s Department of Research and Evaluation.

Chest pains are the second most common cause of emergency department visits by persons with heart disease. These patients are frequently hospitalized for observation and cardiac stress testing, but no studies have evaluated whether such a strategy improves patient health.

Researchers evaluated whether the HEART tool could identify which patients required observation and further testing, and which could be safely discharged. Findings were drawn from the electronic health records of more than 65,000 adult patients evaluated for suspected acute coronary syndrome at 13 Kaiser Permanente emergency departments in Southern California between May 2015 and June 2017.

The study examined outcomes in three periods: from May 2015 to May 2016 before HEART was established, from May 6, 2016 to June 3, 2016 during the transition to HEART, and from June 2016 to June 2017 after HEART was implemented.

The outcomes studied were hospital admissions, non-invasive cardiac stress testing, and whether patients died or had heart attacks within 30 days of the emergency department visit.

According to Kaiser, researchers found that, among emergency room patients with chest pain, there was a 4.4 percent decrease in hospital admissions and cardiac stress testing after implementation of HEART.

Similarly, there was no increase in missed heart attacks after HEART was implemented, and no increase in the rate of death in patients after HEART was implemented.

“Our program to decrease hospitalization of patients with low-risk chest pain builds upon previous efforts to improve care by avoiding unwarranted, potentially harmful treatments such as reducing the prescriptions of antibiotics for acute sinusitis and reducing diagnostic tests such as CT imaging after head trauma,” Sharp said.

Funding for the research work was provided by the National Heart, Lung, and Blood Institute of the National Institutes of Health, according to the statement.

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