Harbor:Stress Testing

• OOP - refer back to in-network PCP for cardio workup

• DHS empaneled - if low risk, message PCP for further cardio workup or schedule for stress test (typically doing CCTA)
  • The 2021 ACC Chest Pain Guidelines 2021 ACC Chest Pain Testing Guidelines (section 4)
    • 2021 AHA ED Chest Pain Testing Algorithm

• DHS Eligible
  • Low risk (HEART score <3, consider<4) - ensure patient goes to Registration Window 6 to finish the Medical application/empanelment process
  • Intermediate to high risk, admit to CORE for further eval (typically CCTA, sometimes nuc test)
  • On the rare occasion you sill feel the need to order the CV Treadmill Stress Test for "Chest Pain", the order goes to the Heart station and they will schedule the patient. It is not done by the ED clerk or ED PAC.
    • Remember, patients should be able to ambulate independently without a cane or walker for about 2 blocks, and make sure the EKG does not have resting ST abnormalities, LBBB, pacing or WPW
    • If they do not meet these criteria, consult cardiology to determine the best option
  • The Cardiology fellow/attending at the Heart Station will further risk stratify
    • If deemed low-risk, stress testing will be deferred to the PCP for follow up
    • If deemed high risk, Cardiology will schedule an alternate non-AGP stress test
  • If the stress test is abnormal, Cardiology will arrange f/up for the patient
    • If test is normal, no notification occurs.

Drs. Chappell & Shah, 5/1/2024