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Paper Chase 3 - HEART Gets Put To The Test

Sanjay Arora, MD and Mike Menchine, MD
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05:41
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Nurses Edition Commentary

Mizuho Spangler, DO
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00:46

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EMRAP 2016 January Summary 874 KB - PDF

The HEART score gets put under the microscope of an RCT and does pretty well. Twice the number of patients discharged from the ED with no major adverse cardiac events at 30 days.

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David G., M.D. -

You are still perpetuating the myth that the AHA guidelines are calling for stress testing within 72 hrs for all low risk patients with a negative work up. You state this in the segment, and even in the segment summary you write, "The official recommendations from the ACC/AHA guidelines still state that even low risk patients with chest pain should receive provocative testing or CT within 72 hours and preferably within 24 hours. "

Fortunately, this is not how the 2014 guidelines read, and although some of this is just semantics, these are important semantics. What the guidelines actually state:

It is reasonable for patients with possible ACS who have normal serial ECGs and cardiac troponins to have a treadmill ECG (200-202) (Level of Evidence: A), stress myocardial perfusion imaging (200), or stress echocardiography (203, 204) before discharge or within 72 hours after discharge. (Level of Evidence: B)

"It is reasonable for patients...to have" sounds to me a lot different than "patients must receive..."
So, if you order such testing, no one from the AHA will call you unreasonable. The flip side however, of whether or not it may also be reasonable to skip these tests in low risk patients, really isn't discussed.

David Glaser
Denver

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Cracking The Chest Full episode audio for MD edition 254:13 min - 354 MB - M4AEMRAP 2016 January Aussie Edition Australian 27:57 min - 38 MB - MP3EMRAP 2016 January Canadian Edition Canadian 15:02 min - 21 MB - MP3EMRAP 2016 Janiver Résumé en Francais Français 63:14 min - 87 MB - MP3EMRAP 2016 Enero Resumen Español Español 83:06 min - 114 MB - MP3EMRAP 2016 January Board Review Answers 120 KB - PDFEMRAP 2016 January Board Review Questions 422 KB - PDFEMRAP 2016 January MP3 314 MB - ZIPEMRAP 2016 January Summary 874 KB - PDF

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