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Rural and socioeconomic differences in the effectiveness of the HEART Pathway accelerated diagnostic protocol.
James C O'Neill1, Nicklaus P Ashburn1,2, Brennan E Paradee1
1Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Summary
The HEART Pathway (accelerated diagnostic protocol) effectively reduced hospitalizations for acute coronary syndrome patients across socioeconomic statuses, but not for rural populations. Death or myocardial infarction rates remained similar for low-risk patients.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Diagnostics
Background:
- The HEART Pathway is a validated accelerated diagnostic protocol (ADP) for patients presenting with possible acute coronary syndrome (ACS).
- This study investigated the safety and effectiveness of the HEART Pathway, specifically analyzing outcomes based on patient rurality and socioeconomic status (SES).
Purpose of the Study:
- To compare the safety and effectiveness of the HEART Pathway in patients stratified by rural versus urban residence.
- To evaluate the HEART Pathway's performance across different socioeconomic statuses (SES).
Main Methods:
- A preplanned subgroup analysis of the HEART Pathway Implementation Study was conducted.
- Primary outcomes included 30-day death or myocardial infarction (MI) and hospitalization.
- Statistical comparisons utilized Fisher's exact tests and logistic regression to assess interactions between ADP implementation, SES, and rurality.
Main Results:
- The HEART Pathway identified a lower proportion of rural and low SES patients as low risk compared to urban and higher SES patients.
- Among low-risk patients, 30-day death or MI rates were similar across rural/urban and low/high SES groups.
- Implementation of the HEART Pathway significantly reduced 30-day hospitalizations for urban and low SES patients, but not for rural patients.
Conclusions:
- HEART Pathway implementation successfully decreased 30-day hospitalizations for urban patients and those with low SES, demonstrating effectiveness across diverse socioeconomic groups.
- The protocol's benefit in reducing hospitalizations was not observed in rural patient populations.
- The 30-day risk of death or MI remained consistent among low-risk patients, irrespective of their rurality or SES.
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