The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge

Circulation. Cardiovascular Quality and Outcomes
Simon A MahlerChadwick D Miller

Abstract

The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by ...Continue Reading

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Citations

Dec 20, 2015·The American Journal of Emergency Medicine·Ken MonahanDaniel Munoz
Jan 1, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Simon A MahlerChadwick D Miller
Aug 2, 2016·Heart, Lung & Circulation·Derek P ChewUNKNOWN NHFA/CSANZ ACS Guideline 2016 Executive Working Group:
Aug 6, 2016·Journal of the American College of Cardiology·Peter W F Wilson, Ralph B D'Agostino
Jun 23, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jason P Stopyra, Simon A Mahler
Oct 22, 2016·The American Journal of Emergency Medicine·Robert F RileySimon A Mahler
Nov 9, 2016·Academic Radiology·Anna M Chang
May 17, 2017·Critical Pathways in Cardiology·Joseph BoveStephen Artim
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Jul 26, 2017·Critical Pathways in Cardiology·Michael R MarchickBrandon R Allen
Jun 14, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jason P StopyraSimon A Mahler
Nov 15, 2017·Critical Pathways in Cardiology·Amy A YauEdward Michaud
Nov 15, 2017·Critical Pathways in Cardiology·Alexandra DavisJonathan Y H Wu
Jun 20, 2018·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jason P StopyraSimon A Mahler
Aug 14, 2018·The Cochrane Database of Systematic Reviews·Camilla StrømJanus C Jakobsen
Mar 5, 2015·Circulation. Cardiovascular Quality and Outcomes·Clare L Atzema, Michael J Schull
Sep 29, 2017·Circulation. Cardiovascular Quality and Outcomes·Tiberio M FrisoliJames McCord
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Feb 15, 2019·Scandinavian Cardiovascular Journal : SCJ·Lars Petter BjørnsenRune Wiseth
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Apr 2, 2019·Circulation Journal : Official Journal of the Japanese Circulation Society·Kazuo KimuraUNKNOWN Japanese Circulation Society Joint Working Group
Jul 13, 2019·Clinical and Experimental Emergency Medicine·Ken MonahanSean P Collins

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