Evidence map›Paper›PMID 36129627›Full record

Observational studyCJEM2022

Can ED chest pain patients with intermediate HEART scores be managed as outpatients?

Aisha Moustapha, Alicia C Mah, Lauren Roberts, Andrew Leach, Glenda Kaban, Rodney Zimmermann, Jay Shavadia, Jason Orvold, Prosanta Mondal, Lynsey J Martin

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in CJEM, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.1field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 7 citations in OpenAlex.

  1. Addressing Frailty in the Emergency Department: Early Outcomes of a Geriatric Rapid Access Clinic.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026
    Article
  2. Article
  3. Article
  4. Article
  5. Early emergency department discharge for intermediate heart score patients presenting for chest pain.Journal of the American College of Emergency Physicians open · 2023
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Aisha MoustaphaCollege of Medicine, University of Saskatchewan, Regina, SK, Canada.ORCID http://orcid.org/0000-0003-2466-0292
Alicia C MahCollege of Medicine, University of Saskatchewan, Regina, SK, Canada.ORCID http://orcid.org/0000-0001-7372-3435
Lauren RobertsDepartment of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada.ORCID http://orcid.org/0000-0002-8649-9943
Andrew LeachDepartment of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada.ORCID http://orcid.org/0000-0002-7087-2758
Glenda KabanDepartment of Emergency Medicine, University of Saskatchewan, Regina, SK, Canada.
Rodney ZimmermannDepartment of Internal Medicine - Division of Cardiology, University of Saskatchewan, Regina, SK, Canada.
Jay ShavadiaDepartment of Internal Medicine - Division of Cardiology, University of Saskatchewan, Saskatoon, SK, Canada.
Jason OrvoldDepartment of Internal Medicine - Division of Cardiology, University of Saskatchewan, Saskatoon, SK, Canada.
Prosanta MondalClinical Research Support Unit, College of Medicine, Saskatoon, SK, Canada.
Lynsey J MartinDepartment of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada. ljm598@mail.usask.ca.
University of Saskatchewan · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCurrent guidelines recommend hospital admission for patients who present to the emergency department (ED) with chest pain and are scored as intermediate risk for adverse outcomes based on the HEART score. While hospital admission for these patients allows for timely investigation and treatment, it is a resource-intensive process. This study examines whether intermediate HEART score patients can be safely managed on an outpatient basis through rapid access chest pain clinics.

methodsThis retrospective observational study included all ED chest pain patients referred to rapid access clinics from January 2018 to April 2020 in Regina and Saskatoon, Saskatchewan. ED physician HEART scores were used in lieu of reviewer HEART scores when available. The primary outcome was the rate of major adverse coronary events (MACE), a composite measure of death, acute coronary syndrome, stroke, coronary angiography, and revascularization at 6 weeks in intermediate-risk patients. Secondary outcomes were the type of MACE, rate of MACE before rapid access clinic appointment and the most predictive component of the HEART score.

resultsThere were 1989 ED referrals, of which 817 were for intermediate-risk patients. 9.3% of intermediate-risk patients had a MACE at 6 weeks. MACE occurred before rapid access clinic follow-up in 1.1% of intermediate-risk patients, with coronary angiography being the most common MACE. Excluding coronary angiography, the risk of MACE before rapid access clinic follow-up was 0.7% in intermediate-risk patients. Components of the HEART score most predictive of MACE were troponin (OR 11.0, 95% CI: 3.7-32.3) and history (5.3, 95% CI: 2.4-11.8).

conclusionThis study demonstrates that rapid access clinics are likely a safe alternative to admission for intermediate-risk chest pain patients and could reduce costly inpatient admissions for chest pain. With angiography excluded, MACE rates were well below the American College of Emergency Physicians cited 2% threshold.

Indexed as

Acute Coronary SyndromeOutpatientsChest PainElectrocardiographyEmergency Service, HospitalHumansRisk AssessmentRisk FactorsTroponinTroponinAcute coronary syndromeChest painHEART scoreMACEOutpatient

Identifiers

PMID36129627
OpenAlexW4296963450

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.