HEART Pathway – Is It Safe a Year Later?

September 8, 2020

Written by Clay Smith

Spoon Feed
The HEART pathway reduced admission and downstream testing for chest pain and was associated with low adverse events one year after implementation.

Why does this matter?
We know patients in the original HEART pathway RCT did well a year out. But what about real-life implementation in a larger population?

Further down the HEART pathway
This was a planned analysis of one year follow up after implementation of the HEART pathway by integration into the Epic EHR in 8,474 patients over age 21 with possible ACS but no STEMI on ECG at 3 EDs. About half the patients were in a cohort before integration of HEART into the EHR and half after. A year later, they found that HEART identified 30.7% of chest pain patients as low risk, and 97.5% of them did not have MI or death (i.e. NPV was 97.5%). Admission for chest pain dropped 7% post-implementation (69% to 62% admit rate). The composite of MI or death occurred in 11.6% of these patients post-implemetation and 12.4% in the pre-implementation cohort (not statistically different). One problem was that 11.6% of patients were lost to follow up post-implementation. That could make a big difference. However, a similar percentage were lost to follow up pre-implementation, and sensitivity analysis showed that MI and death rates were the same no matter how missing data were handled.

Source
HEART Pathway Implementation Safely Reduces Hospitalizations at One Year in Patients With Acute Chest Pain. Ann Emerg Med. 2020 Jul 28:S0196-0644(20)30406-6. doi: 10.1016/j.annemergmed.2020.05.035. Online ahead of print.

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