HEART Pathway Implementation Safely Reduces Hospitalizations at One Year in Patients With Acute Chest Pain - 21/10/20
, Anna C. Snavely, PhD c, Kristin M. Lenoir, MPH c, Brian J. Wells, MD, PhD c, David M. Herrington, MD, MHS d, Brian C. Hiestand, MD, MPH a, Chadwick D. Miller, MD, MS a, Simon A. Mahler, MD, MS a, bAbstract |
Study objective |
We determine whether implementation of the HEART (History, ECG, Age, Risk Factors, Troponin) Pathway is safe and effective in emergency department (ED) patients with possible acute coronary syndrome through 1 year of follow-up.
Methods |
A preplanned analysis of 1-year follow-up data from a prospective pre-post study of 8,474 adult ED patients with possible acute coronary syndrome from 3 US sites was conducted. Patients included were aged 21 years or older, evaluated for possible acute coronary syndrome, and without ST-segment elevation myocardial infarction. Accrual occurred for 12 months before and after HEART Pathway implementation, from November 2013 to January 2016. The HEART Pathway was integrated into the electronic health record at each site as an interactive clinical decision support tool. After integration, ED providers prospectively used the HEART Pathway to identify patients with possible acute coronary syndrome as low risk (appropriate for early discharge without stress testing or angiography) or nonlow risk (appropriate for further inhospital evaluation). Safety (all-cause death and myocardial infarction) and effectiveness (hospitalization) at 1 year were determined from health records, insurance claims, and death index data.
Results |
Preimplementation and postimplementation cohorts included 3,713 and 4,761 patients, respectively. The HEART Pathway identified 30.7% of patients as low risk; 97.5% of them were free of death and myocardial infarction within 1 year. Hospitalization at 1 year was reduced by 7.0% in the postimplementation versus preimplementation cohort (62.1% versus 69.1%; adjusted odds ratio 0.70; 95% confidence interval 0.63 to 0.78). Rates of death or myocardial infarction at 1 year were similar (11.6% versus 12.4%; adjusted odds ratio 1.00; 95% confidence interval 0.87 to 1.16).
Conclusion |
HEART Pathway implementation was associated with decreased hospitalizations and low adverse event rates among low-risk patients at 1-year follow-up.
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| Please see page 556 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Tyler W. Barrett, MD, MSCI. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: JPS, DMH, BCH, CDM, and SAM were responsible for study concept and design. JPS, BCH, CDM, and SAM were responsible for acquisition of data. JPS, ACS, KML, and SAM were responsible for analysis and interpretation of data. JPS, ACS, KML, CDM, and SAM were responsible for drafting the article. All authors were responsible for critical revision of the article. ACS and KML provided statistical expertise. SAM was responsible for acquisition of funding. JPS takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was funded by the Donaghue Foundation and the Association of American Medical Colleges. Dr. Stopyra receives research funding from Abbott Laboratories and Roche Diagnostics. Dr. Miller receives research funding and support from Siemens, Abbott Point of Care, and 1 R01 HL118263. Dr. Mahler receives research funding from Abbott Laboratories, Roche Diagnostics, Siemens, Ortho Clinical Diagnostics, Creavo Medical Technologies, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, and National Heart Lung and Blood Institute (1 R01 HL118263-01, L30 HL120008), and is the Chief Medical Officer for Impathiq Inc. |
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| Trial registration number: NCT02056964 |
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Vol 76 - N° 5
P. 555-565 - novembre 2020 Retour au numéro
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- Global Research Highlights
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