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HEART Pathway Accelerated Diagnostic Protocol Implementation: Prospective Pre-Post Interrupted Time Series Design and

Simon A Mahler1, Gregory L Burke, Pamela W Duncan

  • 1Wake Forest School of Medicine, Department of Emergency Medicine, Winston Salem, NC, United States. smahler@wakehealth.edu.

JMIR Research Protocols
|January 24, 2016
PubMed

Insights

The HEART Pathway (History/ECG/Age/Risk Factors/Troponin) accelerates chest pain diagnosis, safely reducing hospitalizations and length of stay for emergency department patients. This protocol identifies suitable candidates for early discharge, improving healthcare efficiency.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Services Research

Background:

  • Chest pain evaluations in US Emergency Departments (ED) are costly (>$10 billion annually) with low diagnostic yield (<10%) for acute coronary syndrome (ACS).
  • The HEART Pathway (History/ECG/Age/Risk Factors/Troponin) is an accelerated diagnostic protocol (ADP) designed for early ED discharge of low-risk chest pain patients.
  • Prior studies indicate the HEART Pathway safely reduces cardiac testing and hospitalizations.

Purpose of the Study:

  • To determine the effectiveness of implementing the HEART Pathway ADP within a health system.
  • To evaluate the impact of the HEART Pathway on healthcare utilization and patient outcomes.

Main Methods:

  • A controlled before-after study involving approximately 10,000 adult patients with acute chest pain (excluding STEMI) over two years.
  • Outcome measures include hospitalization rates, objective cardiac testing (stress tests, angiography), length of stay, and recurrent cardiac care rates.
  • The HEART Pathway was integrated into electronic medical records for real-time provider decision support.

Main Results:

  • Pilot data showed a 21% reduction in hospitalizations and a median 12-hour reduction in hospital length of stay.
  • No increase in adverse events or recurrent cardiac care was observed.
  • Over 5000 patient encounters have been analyzed, with full electronic health record integration.

Conclusions:

  • The HEART Pathway is hypothesized to safely reduce healthcare utilization for acute chest pain patients.
  • This ADP offers a model for high-value care delivery to millions of US ED patients annually.
  • Implementation demonstrates successful integration and potential for widespread adoption.
Abstract

Keywords:
acute coronary syndromechest paindecision support techniqueelectronic medical recordsimplementation methodsinterrupted time series analysis

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