RAPID-CPU: a prospective study on implementation of the ESC 0/1-hour algorithm and safety of discharge after rule-out of myocardial infarction.
Acute Coronary Syndrome
/ blood
Adult
Aged
Aged, 80 and over
Algorithms
Cardiology
/ organization & administration
Clinical Protocols
/ standards
Comorbidity
Efficiency, Organizational
Emergency Service, Hospital
/ statistics & numerical data
Europe
/ epidemiology
Feasibility Studies
Female
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Myocardial Infarction
/ blood
Patient Discharge
/ statistics & numerical data
Prevalence
Prospective Studies
Safety
Societies, Medical
Time Factors
Troponin T
/ blood
Acute coronary syndrome
clinical protocols
high-sensitivity troponin
real world evidence
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
pubmed:
13
7
2019
medline:
20
11
2020
entrez:
13
7
2019
Statut:
ppublish
Résumé
Although the value of fast diagnostic protocols in suspected acute coronary syndrome has been validated, there is insufficient real world evidence including patients with lower pre-test probability, atypical symptoms and confounding comorbidities. The feasibility, efficacy and safety of European Society of Cardiology (ESC) 0/1 and 0/3-hour algorithms using high-sensitivity troponin T were evaluated in a consecutive cohort with suspected acute coronary syndrome. During 12 months, 2525 eligible patients were enrolled. In a pre-implementation period of 6 months, the prevalence of protocols, disposition, lengths of emergency department stay and treatments were registered. Implementation of the 0/1-hour protocol was monitored for another 6 months. Primary endpoints comprised the change of diagnostic protocols and 30-day mortality after direct discharge from the emergency department. Use of the ESC 0/1-hour algorithm increased by 270% at the cost of the standard 0/3-hour protocol. After rule-out (1588 patients), 1309 patients (76.1%) were discharged directly from the emergency department, with an all-cause mortality of 0.08% at 30 days (one death due to lung cancer). Median lengths of stay were 2.9 (1.9-3.8) and 3.2 (2.7-4.4) hours using a single high-sensitivity troponin T below the limit of detection (5 ng/L) at presentation and the ESC 0/1-hour algorithm, respectively, as compared to 5.3 (4.7-6.5) hours using the ESC 0/3-hour rule-out protocol ( Implementation of the ESC 0/1-hour algorithm is feasible and safe, is associated with shorter emergency department stay than the ESC 0/3-hour protocol, and an increase in discharge rates. ClinicalTrials.gov , Unique identifier: NCT03111862.
Sections du résumé
BACKGROUND
BACKGROUND
Although the value of fast diagnostic protocols in suspected acute coronary syndrome has been validated, there is insufficient real world evidence including patients with lower pre-test probability, atypical symptoms and confounding comorbidities. The feasibility, efficacy and safety of European Society of Cardiology (ESC) 0/1 and 0/3-hour algorithms using high-sensitivity troponin T were evaluated in a consecutive cohort with suspected acute coronary syndrome.
METHODS
METHODS
During 12 months, 2525 eligible patients were enrolled. In a pre-implementation period of 6 months, the prevalence of protocols, disposition, lengths of emergency department stay and treatments were registered. Implementation of the 0/1-hour protocol was monitored for another 6 months. Primary endpoints comprised the change of diagnostic protocols and 30-day mortality after direct discharge from the emergency department.
RESULTS
RESULTS
Use of the ESC 0/1-hour algorithm increased by 270% at the cost of the standard 0/3-hour protocol. After rule-out (1588 patients), 1309 patients (76.1%) were discharged directly from the emergency department, with an all-cause mortality of 0.08% at 30 days (one death due to lung cancer). Median lengths of stay were 2.9 (1.9-3.8) and 3.2 (2.7-4.4) hours using a single high-sensitivity troponin T below the limit of detection (5 ng/L) at presentation and the ESC 0/1-hour algorithm, respectively, as compared to 5.3 (4.7-6.5) hours using the ESC 0/3-hour rule-out protocol (
CONCLUSION
CONCLUSIONS
Implementation of the ESC 0/1-hour algorithm is feasible and safe, is associated with shorter emergency department stay than the ESC 0/3-hour protocol, and an increase in discharge rates.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov , Unique identifier: NCT03111862.
Identifiants
pubmed: 31298551
doi: 10.1177/2048872619861911
pmc: PMC7008552
doi:
Substances chimiques
Troponin T
0
Banques de données
ClinicalTrials.gov
['NCT03111862']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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