title: Cost analysis of the History, ECG, Age, Risk factors, and initial Troponin (HEART) Pathway randomized control trial.
abstract: BACKGROUND
  The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported.
  
  
  RESULTS
  We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol. For low-risk patients, the HEART Pathway recommended early discharge from the emergency department without further testing. We compared index visit cost, cost at 30 days, and cardiac-related health care cost at 30 days between the 2 treatment arms. Costs for each patient included facility and professional costs. Cost at 30 days included total inpatient and outpatient costs, including the index encounter, regardless of etiology. Cardiac-related health care cost at 30 days included the index encounter and costs adjudicated to be cardiac-related within that period. Two hundred seventy of the 282 patients enrolled in the trial had cost data available for analysis. There was a significant reduction in cost for the HEART Pathway group at 30 days (median cost savings of $216 per individual), which was most evident in low-risk (Thrombolysis In Myocardial Infarction score of 0-1) patients (median savings of $253 per patient) and driven primarily by lower cardiac diagnostic costs in the HEART Pathway group.
  
  
  CONCLUSIONS
  Using the HEART Pathway as a decision aid for patients with undifferentiated chest pain resulted in significant cost savings.
authors.affiliation: Division of Cardiology, University of Washington, Seattle, WA. Electronic address: rfriley@uw.edu.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Riley
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Harper
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Hiestand
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Cedric W
authors.initials: CW
authors.lastname: Lefebvre
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Bret A
authors.initials: BA
authors.lastname: Nicks
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: David M
authors.initials: DM
authors.lastname: Cline
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Askew
authors.affiliation: Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Mahler
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000191:economics*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002309:Cardiology; D002637:Chest Pain / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D002985:Clinical Protocols; D017046:Cost Savings / Q000191:economics; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000191:economics; D005080:Exercise Test / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000191:economics; D018570:Risk Assessment / Q000191:economics; D012307:Risk Factors; D014336:Troponin / Q000097:blood; D014481:United States
chemical_list: D014336:Troponin