Effect of a HEART Care Pathway on Chest Pain Management Within an Integrated Health System.

Annals of Emergency Medicine
Adam L SharpBenjamin C Sun

Abstract

We describe the association of implementing a History, ECG, Age, Risk Factors, and Troponin (HEART) care pathway on use of hospital care and noninvasive stress testing, as well as 30-day patient outcomes in community emergency departments (EDs). We performed a prospective interrupted-time-series study of adult encounters for patients evaluated for suspected acute coronary syndrome. The primary outcome was hospitalization or observation, noninvasive stress testing, or both within 30 days. The secondary outcome was 30-day all-cause mortality or acute myocardial infarction. A generalized estimating equation segmented logistic regression model was used to compare the odds of the primary outcome before and after HEART implementation. All models were adjusted for patient and facility characteristics and fit with physicians as a clustering variable. A total of 65,393 ED encounters (before, 30,522; after, 34,871) were included in the study. Overall, 33.5% (before, 35.5%; after, 31.8%) of ED chest pain encounters resulted in hospitalization or observation, noninvasive stress testing, or both. Primary adjusted results found a significant decrease in the primary outcome postimplementation (odds ratio 0.984; 95% confidence interval [CI] 0....Continue Reading

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Oct 6, 2018·Journal of the American College of Cardiology·Adam L SharpBenjamin C Sun

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Citations

Dec 10, 2019·Scandinavian Cardiovascular Journal : SCJ·Ardavan KhoshnoodArash Mokhtari
Jan 16, 2020·Sensors·David Naranjo-HernándezLaura M Roa
Feb 23, 2020·Journal of the American Heart Association·Chengyi ZhengAdam L Sharp
Feb 15, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Danielle E AltmanAdam Sharp
Jan 13, 2021·Circulation. Cardiovascular Quality and Outcomes·Shaw NatsuiAdam L Sharp
Jan 5, 2021·Journal of the American College of Emergency Physicians Open·Kimon L H IoannidesAdam L Sharp
May 3, 2021·Annals of Emergency Medicine·Steven M Green, David L Schriger
Nov 7, 2020·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Chengyi ZhengAdam L Sharp
Nov 16, 2020·The American Journal of Emergency Medicine·Adam L SharpMichael K Gould
Feb 4, 2021·Critical Pathways in Cardiology·Nataisia TerryMichael A Ross

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