The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.
The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.
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DOI：
10.1161/circoutcomes.114.001384
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发表时间：
2015-03
期刊：
影响因子：
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通讯作者：
Miller CD
中科院分区：
文献类型：
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作者：
Mahler SA;Riley RF;Hiestand BC;Russell GB;Hoekstra JW;Lefebvre CW;Nicks BA;Cline DM;Askew KL;Elliott SB;Herrington DM;Burke GL;Miller CD
HEART Pathway是一种决策辅助工具，旨在识别急诊科急性胸痛患者，以便早日出院。没有随机试验比较心脏通路与常规护理。成人急诊科患者的症状与急性冠脉综合征无ST段抬高的心电图（n=282）被随机分配到心脏路径或常规护理。在HEART Pathway组中，急诊科提供者使用HEART评分（一种经验证的决策辅助工具）和0小时和3小时的肌钙蛋白测量值来确定患者是否需要提前出院。住院治疗基于美国心脏病学会/美国心脏协会指南。在30天时通过电话访谈和记录审查评估主要结局、客观心脏测试（负荷测试或血管造影）和次要结局、指数住院时间、提前出院和主要不良心脏事件（死亡、心肌梗死或冠状动脉血运重建）。受试者平均年龄为53岁，16%有心肌梗死病史，6%（95%置信区间，3.6%-9.5%）在随机分组后30天内有严重不良心脏事件。与常规治疗相比，使用HEART Pathway使30天时的客观心脏检查减少了12.1%（68.8%对56.7%; P=0.048），住院时间减少了12小时（9.9对21.9小时; P=0.013），早期出院增加了21.3%（39.7%对18.4%; P<0.001）。确定提前出院的患者在30天内没有发生重大不良心脏事件。HEART Pathway减少了30天内的客观心脏检查，缩短了住院时间，并增加了早期出院。这些重要的效率提高发生时，没有任何患者在30天时发生MACE而被确定为提前出院。
The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%–9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days. The HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days.