Emergency Rooms Frequently Mismanage Potential Major Adverse Cardiac Events (MACE)
Each year hundreds of thousands of men and women visit hospitals for emergency treatment of chest pain. In the majority of such cases, no evidence of heart trouble is found and the patient is discharged home with instructions to follow up with their health care provider or to return to the hospital if their symptoms occur again. In order to reduce the number of patients who will later suffer a major adverse cardiac event (a heart attack, a stroke, or require urgent heart bypass surgery), most hospital emergency rooms have standard protocols or “check systems” in place that can reliably identify those patients at greatest risk of future complications.
One of the most widely-used systems for evaluating chest pain in the Emergency Room patient is called the HEART protocol or “score” This system evaluates the patient for the presence or absence of five separate physical signs, symptoms, or lab results which are assigned a “score” of from 0 to 2. The five scores are then added together, with the higher scores suggesting a higher probability of the presence of heart disease and/or a MACE within 6 weeks of the patient’s initial hospital visit.
Current Medical History
0 = Slightly suspicious for heart disease
1 = Moderately suspicious
2 = Strongly suspicious
0 = No changes
1 = minor but non-specific changes
2 = major changes suggestive of heart disease
0 = < 45 years of age
1 = < 45 – 64 years old
2 = > 65 years old
Risk Factors for Heart Disease
0 = No risk factors
1 = 1 or 2 risk factors
2 = 3 or more risk factors
Troponin (an enzyme that detects injury to heart muscle) Level
0 = < lab’s normal upper limit
1 = 1 – 3 X lab’s normal upper limit
2 = > 3 X lab’s normal upper limit
Those readers with a medical background can review this page for more technical information regarding HEART and MACE.
Obviously, no system is perfect and there will always be cases that are misdiagnosed by even the most conscientious physicians. Given its proven utility in identifying high-risk patients, the HEART system is considered the “gold standard” by national medical groups such as the American College of Cardiology and the American College of Emergency Physicians. Thus, a failure to use and document the results of a HEART protocol on the patient’s medical record could be interpreted as a matter of medical malpractice.
If you or a family member suffered a heart attack after being sent home from a hospital Emergency Room and you feel the Emergency Room staff may have not taken all the HEART criteria into consideration, we invite you to contact the medical malpractice lawyer at The Doan Law Firm to arrange a free review of the facts in your case and a discussion of the legal options that may be available to you.
When you contact The Doan Law Firm, there is never a charge of any kind for your case review or for you to speak directly with our medical malpractice lawyer. Should you later decide that a lawsuit is in order and that you would like for our firm to represent you in court, we are willing to assume full responsibility for all aspects of preparing your case for trial in exchange for a percentage of the final decision we are prepared to win for you.