• Simon A Mahler, Robert F Riley, Brian C Hiestand, Gregory B Russell, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Stephanie B Elliott, David M Herrington, Gregory L Burke, and Chadwick D Miller.
• From the Department of Emergency Medicine (S.A.M., B.C.H., J.W.H., C.W.L., B.A.N., D.M.C., K.L.A., S.B.E., C.D.M.), Division of Cardiology, Department of Internal Medicine (R.F.R., D.M.H.), Department of Biostatistical Sciences (G.B.R.), and Division of Public Health Sciences (G.L.B.), Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC. smahler@wakehealth.edu.
• Circ Cardiovasc Qual. 2015 Mar 1;8(2):195-203.

BackgroundThe HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care.Methods And ResultsAdult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days.ConclusionsThe HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique Identifier: NCT01665521.© 2015 American Heart Association, Inc.

41 keywords...

hide…