Researchers at Wake Forest Baptist Medical Center have developed a medical app for risk-evaluation and clinical support that can help emergency department personnel more efficiently determine which patients with acute chest pain can be discharged safely.
The app, called the HEART Pathway, is now available as a free download in the Apple App Store and is based on a clinically validated protocol developed by researchers at Wake Forest Baptist.
Released in the spring of 2016, the app also integrates seamlessly with electronic health record systems such as EPIC. This integration functionality can be purchased as an enterprise solution from Decision Point Informatics, an industry partner that has licensed related intellectual property rights from Wake Forest Baptist Health through Wake Forest Innovations.
A randomized control clinical trial published in Circulation: Cardiovascular Quality and Outcomes (March 2015) a journal of the American Heart Association found that chest-pain patients who were evaluated with the HEART Pathway protocol, had 12 percent fewer cardiac tests, 21 percent more early discharges and shorter hospital stays than those who received standard care. No patient identified for early discharge had a major heart problem within 30 days of their admission to the emergency department.
With the validated results of the study, lead author and associate professor of emergency medicine at Wake Forest Baptist, Simon A. Mahler, M.D., along with Iltifat Husain, M.D., assistant professor of Emergency Medicine at Wake Forest Baptist, worked to translate the HEART Pathway protocol and decision support into an app interface with the help of Wake Forest School of Medicine student Scott Gilmore.
“The HEART Pathway app is the manifestation of our validated patient protocol in digital form,” Mahler said. “This gives emergency department providers an easy way to apply an already proven method for evaluating patients who present with chest pain in a way that reduces length of stay and unnecessary testing.”
The HEART Pathway weighs five components: the patient’s history, electrocardiogram, age, risk factors and levels of troponin, a protein in blood released when the heart muscle is damaged to determine an individual’s risk of having a serious cardiac problem.
The app allows the medical provider to input this information and then produces a HEAR score (history, ECG, age and risk factors) between 0 and 7, along with a recommendation for troponin measurement. Patients with a HEAR score of 3 or lower and negative serial troponins have less than 1 percent risk of a major adverse cardiac event (MACE) within 30 days and are recommended for release.
Unlike the HEART Score, a related decision aid which has a 2 percent risk of missing a cardiac event, the HEART Pathway has less than a 1 percent risk. More importantly, compared to the HEART Score, the HEART Pathway is a less subjective that delivers greater reproducibility independent of the provider using it. This enables uniform care to be delivered to patients.
“The ability to have an app on hand that can provide a validated health pathway and have that same app integrated into EPIC has the potential to provide not only better patient care in emergency care settings everywhere, but to provide substantial cost savings to health systems, insurers and patients by reducing testing and admission. Through rigorous research and time we’ve proven the HEART Pathway works not only at Wake Forest Baptist, but also at other private practice emergency rooms. Now we want to take it nationwide” said Husain.
Wake Forest Innovations
Wake Forest Baptist Medical Center