HEART pathway can safely identify low-risk ER patients

(HealthDay)—Implementation of the HEART Pathway is associated with decreased hospitalizations, increased identification of myocardial infarction (MI) at the index visit, and a very low death and MI rate among low-risk emergency department patients with chest pain, according to a study published online Sept. 28 in Circulation: Cardiovascular Quality and Outcomes.

Simon A. Mahler, M.D., from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues studied outcomes 12 months before and after implementation to assess whether implementation of the HEART Pathway is safe (30-day death and MI rate <1 percent in low-risk patients) and effective (reduces 30-day hospitalizations) in 8,474 adult emergency department patients presenting at three sites with possible acute coronary syndrome.

Based on data from 3,713 pre-implementation and 4,761 post-implementation patients, the researchers found that the HEART Pathway identified 30.7 percent of patients as low risk and 0.4 percent of these patients experienced death or MI within 30 days. Post-implementation, hospitalization at 30 days was 6 percent lower than in the pre-implementation cohort (adjusted odds ratio [aOR], 0.79; 95 percent confidence interval, 0.71 to 0.87) and more MIs were detected at the index visit versus pre-implementation (aOR, 1.36; 95 percent confidence interval, 1.12 to 1.65). During follow-up, rates of death or MI were similar (aOR, 0.88; 95 percent confidence interval, 0.58 to 1.33).

“These findings support use of the HEART Pathway to identify low-risk patients that can be safely discharged without stress testing or angiography,” conclude the authors.

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