Accelerated Specialty Entry (ASE): Redesigning the Pathway to Cardiovascular Specialty Appointments

Outpatient cardiovascular referral has traditionally defined the first in-person cardiologist evaluation as the beginning of specialty care, leaving the referral interval largely inactive. The Accelerated Specialty Entry (ASE) Framework redesigns this architecture by initiating specialist-directed cardiovascular assessment immediately following primary care referral. This study evaluated the novel first implementation of the ASE pathway in routine outpatient practice.

This prospective implementation study was conducted from September 2025 to February 2026 in central New Jersey using a virtual cardiovascular platform. Following primary care referral, patients underwent a virtual ASE Assessment by supervised cardiology advanced practice providers before their first available in-person cardiologist evaluation. The primary outcome was time from patient engagement to the first available cardiologist evaluation. Secondary outcomes included pathway completion, patient experience, and short-term safety.

Forty-eight patients were referred, 31 enrolled, and 30 completed the pathway. All enrolled participants completed an ASE Assessment, and 30 of 31 (97%) completed an in-person cardiologist evaluation. Mean time from patient engagement to the first available cardiologist evaluation was 3.1 ± 1.4 days versus a previously reported national wait-time benchmark of 32.7 days. All participants were offered an evaluation within 5 days; 15 (50%) accepted the first available appointment. No triage-related adverse events occurred during 60-day follow-up.

The ASE Framework redesigns referral workflow by advancing specialist-directed cardiovascular assessment to immediately follow primary care referral. In its first implementation, the ASE Pathway integrated into routine outpatient practice and was associated with substantially shorter time to the first available cardiologist evaluation.