Sex and race differences in safety and effectiveness of the HEART pathway accelerated diagnostic protocol for acute chest pain - 23/01/21
, Nella Hendley, MD, MA a, Jason P. Stopyra, MD, MS a, 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, bRésumé |
Background |
The HEART Pathway is an accelerated diagnostic protocol for Emergency Department patients with possible acute coronary syndrome. The objective was to compare the safety and effectiveness of the HEART Pathway among women vs men and whites vs non-whites.
Methods |
A subgroup analysis of the HEART Pathway Implementation Study was conducted. Adults with chest pain were accrued from November 2013 to January 2016 from 3 Emergency Departments in North Carolina. The primary outcomes were death and myocardial infarction (MI) and hospitalization rates at 30 days. Logistic regression evaluated for interactions of accelerated diagnostic protocol implementation with sex or race and changes in outcomes within subgroups.
Results |
A total of 8,474 patients were accrued, of which 53.6% were female and 34.0% were non-white. The HEART Pathway identified 32.6% of females as low-risk vs 28.5% of males (P = 002) and 35.6% of non-whites as low-risk vs 28.0% of whites (P < .0001). Among low-risk patients, death or MI at 30 days occurred in 0.4% of females vs 0.5% of males (P = .70) and 0.5% of non-whites vs 0.3% of whites (P = .69). Hospitalization at 30 days was reduced by 6.6% in females (aOR: 0.74, 95% CI: 0.64-0.85), 5.1% in males (aOR: 0.87, 95% CI: 0.75-1.02), 8.6% in non-whites (aOR: 0.72, 95% CI: 0.60-0.86), and 4.5% in whites (aOR: 0.83, 95% CI: 0.73-0.94). Interactions were not significant.
Conclusion |
Women and non-whites are more likely to be classified as low-risk by the HEART Pathway. HEART Pathway implementation is associated with decreased hospitalizations and a very low death and MI rate among low-risk patients regardless of sex or race.
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| Funding: This project was funded by the Donaghue Foundation and the Association of American Medical Colleges (AAMC). Dr. Snavely also receives funding from NHLBI (R01 HL118263–01). Dr. Mahler also receives research funding from Abbott Laboratories, Roche Diagnostics, Siemens, Ortho Clinical Diagnostics, Creavo Medical Technologies, PCORI, AHRQ, and NHLBI (1 R01 HL118263–01, L30 HL120008). Dr. Miller also receives research funding / support from Siemens, Abbott Point of Care, and 1 R01 HL118263–01. Dr. Mahler is the Chief Medical Officer for Impathiq Inc. |
Vol 232
P. 125-136 - février 2021 Retour au numéro
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