Related Experiment Video
Updated: Dec 6, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
The disutility of stress testing in low-risk HEART Pathway patients
Nicklaus P Ashburn1, Zachary P Smith1, Kale J Hunter1
1Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States.
Insights
Stress testing for low-risk chest pain patients using the HEART Pathway was infrequent and rarely identified significant coronary artery disease. Males and those with higher HEAR scores were more likely to receive testing.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- The HEART Pathway is designed to identify low-risk chest pain patients for early discharge without stress testing.
- Adherence to HEART Pathway recommendations for stress testing varies in clinical practice.
- Understanding the utilization and yield of stress testing in this population is crucial for optimizing patient care.
Purpose of the Study:
- To determine the frequency of stress testing in low-risk chest pain patients identified by the HEART Pathway.
- To evaluate the diagnostic yield of stress testing in this specific patient group.
- To identify factors associated with undergoing stress testing despite low-risk stratification.
Main Methods:
- Analysis of a hospital's chest pain registry for low-risk HEART Pathway patients (HEAR score ≤ 3, negative troponins).
- Review of stress test results for inducible ischemia and correlation with coronary angiography findings.
- Statistical analysis, including logistic regression, to identify predictors of stress testing.
Main Results:
- Of 4743 total assessments, 43.7% were low-risk (2074 patients).
- Stress testing was performed in only 4.1% (84/2074) of low-risk patients.
- The diagnostic yield for obstructive coronary artery disease was low at 1.2% (1/84), with positive tests being rare and often inconclusive.
Conclusions:
- Stress testing is infrequently utilized in low-risk chest pain patients identified by the HEART Pathway.
- When performed, stress testing in this population has a low diagnostic yield for significant coronary artery disease.
- Higher HEAR scores and male sex were associated with increased likelihood of receiving stress testing.
Background:
The HEART Pathway identifies low-risk chest pain patients for discharge from the Emergency Department without stress testing. However, HEART Pathway recommendations are not always followed. The objective of this study is to determine the frequency and diagnostic yield of stress testing among low-risk patients.
Methods:
An academic hospital's chest pain registry was analyzed for low-risk HEART Pathway patients (HEAR score ≤ 3 with non-elevated troponins) from 1/2017 to 7/2018. Stress tests were reviewed for inducible ischemia. Diagnostic yield was defined as the rate of obstructive CAD among patients with positive stress testing. T-test or Fisher's exact test was used to test the univariate association of age, sex, race/ethnicity, and HEAR score with stress testing. Multivariate logistic regression was used to determine the association of age, sex, race/ethnicity, and HEAR score with stress testing.
Results:
There were 4743 HEART Pathway assessments, with 43.7% (2074/4743) being low-risk. Stress testing was performed on 4.1% (84/2074). Of the 84 low-risk patients who underwent testing, 8.3% (7/84) had non-diagnostic studies and 2.6% (2/84) had positive studies. Among the 2 patients with positive studies, angiography revealed that 1 had widely patent coronary arteries and the other had multivessel obstructive coronary artery disease, making the diagnostic yield of stress testing 1.2% (1/84). Each one-point increase in HEAR score (aOR 2.17, 95% CI 1.45-3.24) and being male (aOR 1.59, 95% CI 1.02-2.49) were associated with testing.
Conclusions:
Stress testing among low-risk HEART Pathway patients was uncommon, low yield, and more likely in males and those with a higher HEAR score.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
12:12Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice
Published on: February 14, 2017
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...