HEART Pathway Accelerated Diagnostic Protocol Implementation: Prospective Pre-Post Interrupted Time Series Design and Methods

JMIR Research Protocols
Simon A MahlerChadwick D Miller

Abstract

Most patients presenting to US Emergency Departments (ED) with chest pain are hospitalized for comprehensive testing. These evaluations cost the US health system >$10 billion annually, but have a diagnostic yield for acute coronary syndrome (ACS) of <10%. The history/ECG/age/risk factors/troponin (HEART) Pathway is an accelerated diagnostic protocol (ADP), designed to improve care for patients with acute chest pain by identifying patients for early ED discharge. Prior efficacy studies demonstrate that the HEART Pathway safely reduces cardiac testing, while maintaining an acceptably low adverse event rate. The purpose of this study is to determine the effectiveness of HEART Pathway ADP implementation within a health system. This controlled before-after study will accrue adult patients with acute chest pain, but without ST-segment elevation myocardial infarction on electrocardiogram for two years and is expected to include approximately 10,000 patients. Outcomes measures include hospitalization rate, objective cardiac testing rates (stress testing and angiography), length of stay, and rates of recurrent cardiac care for participants. In pilot data, the HEART Pathway decreased hospitalizations by 21%, decreased hospital length (me...Continue Reading

Associated Clinical Trials

References

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Citations

Jun 9, 2016·JMIR Research Protocols·Maria Francesca RomanoFabrizio Alboni
Sep 18, 2016·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Matthew C DeLaneyJared J Thomas
Mar 10, 2018·Inflammatory Bowel Diseases·Brittany LitsterR A Marrie
Nov 15, 2019·Critical Pathways in Cardiology·Michael I BrenerLeRoy E Rabbani
May 16, 2018·The Western Journal of Emergency Medicine·William D AlleySimon A Mahler
Aug 6, 2020·Emergency Medicine Journal : EMJ·Lane M SmithSimon A Mahler
Jun 22, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Bret A Nicks, Brian C Hiestand
Nov 15, 2017·Critical Pathways in Cardiology·Amy A YauEdward Michaud
Jan 25, 2021·The Journal of Emergency Medicine·Dipanjan HalderRajiv Narang
Aug 2, 2020·Annals of Emergency Medicine·Jason P StopyraSimon A Mahler

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Clinical Trials Mentioned

NCT02056964

Software Mentioned

HEART
EPIC
HEART Pathway CDS
Clarity
HEART Pathway
HEART Pathway ADP

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