Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute
Simon A Mahler1,2,3, Nicklaus P Ashburn1,4, Brennan E Paradee1
1Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC.
The high-sensitivity HEART Pathway (hs-HP) safely increased early discharges for patients with possible acute coronary syndrome. This approach improved chest pain care by reducing hospitalizations without raising adverse events like death or myocardial infarction.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Risk Stratification
Background:
- The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) aids in risk stratification for acute coronary syndrome (ACS).
- Data on the safety and effectiveness of the high-sensitivity HEART Pathway (hs-HP) in emergency departments is limited.
Purpose of the Study:
- To evaluate the safety and effectiveness of a modified high-sensitivity HEART Pathway (hs-HP) for risk stratification in emergency department patients with possible ACS.
- To assess the impact of hs-HP implementation on key safety and effectiveness outcomes, including early discharge rates.
Main Methods:
- An interrupted time series study involving 26,126 adult patients across 5 North Carolina sites.
- Comparison of preimplementation (traditional HEART Pathway with contemporary troponin) and postimplementation (modified hs-HP with high-sensitivity troponin) cohorts.
- Primary outcomes included 30-day all-cause death or myocardial infarction (MI) and 30-day hospitalizations; secondary outcome was early discharge rate.
Main Results:
- No significant difference in 30-day death or MI rates between hs-HP (6.8%) and traditional HEART Pathway (7.7%) implementation (aOR, 1.00).
- hs-HP implementation was associated with a significant increase in early discharges (63.6% vs. 43.7%; aOR, 2.22) and a decrease in 30-day hospitalizations (31.4% vs. 47.5%; aOR, 0.51).
- Among early discharge patients, 30-day death or MI rates were low and similar between cohorts (0.5% postimplementation vs. 0.4% preimplementation).
Conclusions:
- Implementation of a modified hs-HP is safe and effective for risk stratification in emergency department patients with possible ACS.
- The hs-HP strategy is associated with increased early discharges and reduced hospitalizations without compromising patient safety.
- Findings support the adoption of the modified hs-HP to enhance the efficiency and effectiveness of chest pain care in the emergency department.
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