HEART Pathway
The HEART Pathway Randomized Trial
Patient / Population Intervention / Exposition Vergleich Endpunkt
In282 emergency department patients with acute chest pain,the HEART Pathwayreducedobjective cardiac testing at 30 dayscompared withusual care.
N
282
Design
Single-center, open-label randomized controlled trial at a US academic emergency department (September 2012–February 2014); 282 adults with possible acute coronary syndrome and no ST-elevation randomized 1:1 to HEART Pathway (HEART score plus 0- and 3-hour troponin) or usual care; powered at 90% to detect a 15% absolute reduction in objective cardiac testing.
Endpunkt
Objective cardiac testing (stress testing or coronary angiography) within 30 days; secondary: index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, revascularization) at 30 days.
ErgebnisObjective cardiac testing at 30 days 56.7% (80/141) with the HEART Pathway versus 68.8% (97/141) with usual care, an absolute reduction of 12.1% (P=0.048). Early discharge 39.7% versus 18.4% (absolute increase 21.3%, P<0.001) and median length of stay 9.9 versus 21.9 hours (P=0.013). Major adverse cardiac events occurred in 6% overall (17/282; 95% CI 3.6%–9.5%), with no events among the 66 patients identified as low risk by the HEART Pathway. Follow-up at 30 days was 96%.
Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203. 10.1161/circoutcomes.114.001384