The HEART Pathway Randomized Controlled Trial One-year Outcomes.
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
09
04
2018
revised:
01
06
2018
accepted:
07
06
2018
pubmed:
20
6
2018
medline:
15
11
2019
entrez:
20
6
2018
Statut:
ppublish
Résumé
The objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain. Adult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests. A total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%-100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36). The HEART Pathway had a 100% NPV for 1-year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1-year objective testing was not significant.
Identifiants
pubmed: 29920834
doi: 10.1111/acem.13504
pmc: PMC6934171
mid: NIHMS1059258
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
41-50Subventions
Organisme : American Heart Association-American Stroke Association
ID : 13CRP17090055
Pays : United States
Organisme : Duke Endowment
Pays : International
Organisme : American Heart Association-American Stroke Association
ID : 12CRP12000001
Pays : United States
Organisme : Abbott Point of Care
Pays : International
Organisme : NCRR NIH HHS
ID : M01 RR007122
Pays : United States
Organisme : Roche Diagnostics
Pays : International
Organisme : Siemens by providing software for cardiac imaging research
Pays : International
Organisme : SAM is the chief medical officer of Impathiq, Inc.
Pays : International
Organisme : Wake Forest Translational Science Institute
Pays : International
Organisme : NHLBI NIH HHS
ID : L30 HL120008
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL118263
Pays : United States
Organisme : AAMC/Donaghue Foundation
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2018 by the Society for Academic Emergency Medicine.
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