Effect of a HEART Care Pathway on Chest Pain Management Within an Integrated Health System.
Acute Coronary Syndrome
/ complications
Acute Disease
Adult
Aged
California
/ epidemiology
Chest Pain
/ diagnosis
Clinical Observation Units
/ statistics & numerical data
Delivery of Health Care, Integrated
/ standards
Emergency Service, Hospital
/ standards
Exercise Test
/ methods
Female
Hospitalization
/ statistics & numerical data
Humans
Interrupted Time Series Analysis
/ methods
Male
Middle Aged
Mortality
Myocardial Infarction
/ complications
Pain Management
/ methods
Prospective Studies
Quality of Health Care
/ standards
Risk Factors
Troponin
/ metabolism
Journal
Annals of emergency medicine
ISSN: 1097-6760
Titre abrégé: Ann Emerg Med
Pays: United States
ID NLM: 8002646
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
12
09
2018
revised:
17
12
2018
accepted:
31
12
2018
pubmed:
25
2
2019
medline:
13
3
2020
entrez:
25
2
2019
Statut:
ppublish
Résumé
We describe the association of implementing a History, ECG, Age, Risk Factors, and Troponin (HEART) care pathway on use of hospital care and noninvasive stress testing, as well as 30-day patient outcomes in community emergency departments (EDs). We performed a prospective interrupted-time-series study of adult encounters for patients evaluated for suspected acute coronary syndrome. The primary outcome was hospitalization or observation, noninvasive stress testing, or both within 30 days. The secondary outcome was 30-day all-cause mortality or acute myocardial infarction. A generalized estimating equation segmented logistic regression model was used to compare the odds of the primary outcome before and after HEART implementation. All models were adjusted for patient and facility characteristics and fit with physicians as a clustering variable. A total of 65,393 ED encounters (before, 30,522; after, 34,871) were included in the study. Overall, 33.5% (before, 35.5%; after, 31.8%) of ED chest pain encounters resulted in hospitalization or observation, noninvasive stress testing, or both. Primary adjusted results found a significant decrease in the primary outcome postimplementation (odds ratio 0.984; 95% confidence interval [CI] 0.974 to 0.995). This resulted in an absolute adjusted month-to-month decrease of 4.39% (95% CI 3.72% to 5.07%) after 12 months' follow-up, with a continued trend downward. There was no difference in 30-day mortality or myocardial infarction (0.6% [before] versus 0.6% [after]; odds ratio 1.02; 95% CI 0.97 to 1.08). Implementation of a HEART pathway in the ED evaluation of patients with chest pain resulted in less inpatient care and noninvasive cardiac testing and was safe. Using HEART to risk stratify chest pain patients can improve the efficiency and quality of care.
Identifiants
pubmed: 30797573
pii: S0196-0644(19)30007-1
doi: 10.1016/j.annemergmed.2019.01.007
pmc: PMC6650318
mid: NIHMS1518104
pii:
doi:
Substances chimiques
Troponin
0
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
171-180Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL134647
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001883
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
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