安全识别急诊室急性胸痛患者及早出院
Simon A Mahler1,2,3, 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
概括
心脏路径 (病史,心电图,年龄,风险因素,Troponin) 可以安全地识别低风险的胸痛患者. 实施减少了住院病例,同时保持了低死亡率和心肌梗塞.
科学领域:
- 心脏病学
- 紧急医疗
- 临床决策支持
背景情况:
- 心脏路径是一个加速诊断方案急诊室患者胸痛.
- 它的目的是识别低风险的个体,以便在没有进一步测试的情况下提前出院.
研究的目的:
- 评估实施HEART途径的安全性和有效性.
- 确定该方案是否可以减少急性冠状动脉综合征患者的30天住院时间.
主要方法:
- 这是一项前后前性研究,涉及美国3个地区的8474名成年患者.
- 作为一个决策支持工具,HEART路径被整合到电子健康记录中.
- 结果 (死亡,心脏病发作,住院) 在实施后的30天内被跟踪.
主要成果:
- 心脏病途径发现30. 7%的患者患有低风险,30日死亡率或心脏病发作率为0. 4%.
- 在实施后,住院病例减少了6% (55.6% vs 61.6%).
- 在实施后的队列中,指数访问MI增加了 (6. 6% 与 5. 7% 相比).
结论:
- 实施HEART途径减少了住院病例,并增加了早期MI检测.
- 在低风险患者中观察到非常低的死亡率和心脏病发作率.
- 这些发现支持使用HEART途径在没有压力测试或血管造影的情况下安全提前出院.
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