急性胸痛患者の早期出院を安全に確認する

Simon A Mahler^1,2,3, Kristin M Lenoir⁴, Brian J Wells⁴

¹Department of Emergency Medicine (S.A.M., B.C.H., C.D.M.), Wake Forest School of Medicine, Winston-Salem, NC.

Circulation

|December 21, 2018

まとめ

HEART Pathway (経歴,心電図,年齢,リスク因子,トロポニン) は,低リスクの胸痛患者の早期出院を安全に特定します. 導入により,入院が減ったが,死亡率と心筋梗塞は低かった.

科学分野:

心臓病科
緊急医療
臨床的意思決定支援

背景:

ハート・パスウェイは胸の痛みを感じる緊急治療室の患者のための急速診断プロトコルです
早期出院のための低リスクの個人を特定することを目的としています.

研究の目的:

ハート・パスウェイの安全性と有効性を評価する.
急性冠動脈症候群の患者の30日間の入院を減らすかどうかを判断する.

主な方法:

米国3カ所の8474人の成人を対象とした前後の研究.
HEART Pathwayは意思決定支援ツールとして電子医療記録に統合されました.
結果 (死亡,心臓発作,入院) は,導入後30日間追跡された.

主要な成果:

HEART Pathwayでは,患者の30. 7%が低リスクで,30日間の死亡率またはMI率は0. 4%であった.
導入後の入院は6%減少した (55. 6% vs 61. 6%).
インデックス訪問MIは,導入後のコホートで増加した (6. 6% 対 5. 7%).

結論:

HEART Pathwayの導入により,入院が減り,早期発作の検出が増加しました.
低リスクの患者では,非常に低い死亡率と心臓発作の割合が観察されました.
ストレス検査や血管検査なしで早期出院を安全にするために HEART パスウェイを使用することを支持しています

キーワード:

急性冠動脈症候群臨床的意思決定決定支援システム,臨床電子医療記録緊急医療リスク評価

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