{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Stopyra JP"],"funding":["Roche Diagnostics","NCRR NIH HHS","American Heart Association-American Stroke Association","NHLBI NIH HHS","Association of American Medical Colleges","Wake Forest Translational Science Institute","Duke Endowment","American Heart Association","Abbott Point of Care","National Heart and Lung Institute","SAM is the chief medical officer of Impathiq, Inc.","Siemens by providing software for cardiac imaging research","AAMC/Donaghue Foundation"],"pagination":["41-50"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC6934171"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["26(1)"],"pubmed_abstract":["OBJECTIVE:The objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain. METHODS:Adult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests. RESULTS:A total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%-100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36). CONCLUSIONS:The HEART Pathway had a 100% NPV for 1-year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1-year objective testing was not significant."],"journal":["Academic emergency medicine : official journal of the Society for Academic Emergency Medicine"],"pubmed_title":["The HEART Pathway Randomized Controlled Trial One-year Outcomes."],"pmcid":["PMC6934171"],"funding_grant_id":["13CRP17090055","R01 HL118263","L30 HL120008","12CRP12000001","M01 RR007122"],"pubmed_authors":["Hiestand BC","Askew KL","Russell GB","Hoekstra JW","Herrington DM","Riley RF","Cline DM","Burke GL","Mahler SA","Lefebvre CW","Miller CD","Stopyra JP","Nicks BA","Elliott SB"],"additional_accession":[]},"is_claimable":false,"name":"The HEART Pathway Randomized Controlled Trial One-year Outcomes.","description":"OBJECTIVE:The objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain. METHODS:Adult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests. RESULTS:A total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%-100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36). CONCLUSIONS:The HEART Pathway had a 100% NPV for 1-year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1-year objective testing was not significant.","dates":{"release":"2019-01-01T00:00:00Z","publication":"2019 Jan","modification":"2024-02-15T11:18:24.66Z","creation":"2020-10-29T13:25:44Z"},"accession":"S-EPMC6934171","cross_references":{"pubmed":["29920834"],"doi":["10.1111/acem.13504"]}}