Trial reportCirculation. Cardiovascular quality and outcomes2015
The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.
Trial report in Circulation. Cardiovascular quality and outcomes, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 177 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy Evaluation of the HEART Pathway in Emergency Department Patients With Acute Chest Pain
Can Pre-Hospital Use of the HEART Score and Abbott i-STAT® Point-of-Care Troponin Predict Major Adverse Cardiovascular Events: the PARA-HEART Pilot Implementation
Standardizing Emergency Work-ups Around Risk Data (STEWARD): The CREST Network Chest Pain Project
Translating Evidence-Based Chest Pain Decision Aids to the Prehospital Environment
Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients (E-VICTORS) Project
Diagnostic Accuracy of Large Language Models (GPT-4o and Claude) in HEART Score Calculation and 30-Day MACE Prediction in Emergency Department Chest Pain Patients: A Prospective Observational Validation Study Against Three-Expert Consensus
Who cites it
177 citing papers in PubMed, 3 syntheses or guidelines pooled it, 385 citations in OpenAlex.
- A meta-analysis on the safety and accuracy of the HEART pathway for risk stratification in patients with acute chest pain.BMC cardiovascular disorders · 2025Pooled it
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Hospitalisation in short-stay units for adults with internal medicine diseases and conditions.The Cochrane database of systematic reviews · 2018Pooled it
- ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain.Critical pathways in cardiology · 2019Trial
- The HEART Pathway Randomized Controlled Trial One-year Outcomes.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Trial
- Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain: A Secondary Analysis of the ROMICAT-II Randomized Clinical Trial.JAMA internal medicine · 2018Trial
- Validation of the No Objective Testing Rule and Comparison to the HEART Pathway.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2017Trial
- Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis.Clinical biochemistry · 2017Trial
- Chest Pain Risk Stratification: A Comparison of the 2-Hour Accelerated Diagnostic Protocol (ADAPT) and the HEART Pathway.Critical pathways in cardiology · 2016Trial
- Adherence to an Accelerated Diagnostic Protocol for Chest Pain: Secondary Analysis of the HEART Pathway Randomized Trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2016Trial
- Chest pain in the emergency room: value of the new HEAR score identifying patients with low risk of acute coronary syndrome without troponin testing.Clinics (Sao Paulo, Brazil) · 2026Article
- Using Sydney Triage to Admission Risk Tool With Artificial Intelligence (START-AI) to Predict Inpatient Admitting Specialty for Emergency Department Patients: Single Centre Deep Learning Analysis.Emergency medicine Australasia : EMA · 2026Article
- Natural Language Processing for Risk Stratification of Emergency Department Patients with Chest Pain.CJC open · 2026Article
- HEART Score Distribution and Association with In-Hospital Management and Outcomes in COVID-19 Survivors Presenting with Acute Chest Pain.Journal of clinical medicine · 2026Article
- Risk Stratification in Cardiovascular Medicine for Prognostic Assessment and Therapeutic Decision-Making: From Atrial Fibrillation to the Broader Disease Spectrum.Journal of arrhythmia · 2026Review
- Artificial Intelligence-Driven Cost Savings from Emergency Department Chest Pain Patient Evaluation: A Monte Carlo Simulation.The western journal of emergency medicine · 2026Article
- Performance of the SVEAT (Symptoms, Vascular Disease History, Electrocardiography, Age, and Troponin) score for predicting 90-day major adverse cardiac events in patients with acute chest pain.BMC emergency medicine · 2026Article
- Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain.Journal of cardiovascular development and disease · 2026Article
- Article
- Sex differences in acute chest pain care in a multisite U.S. emergency department cohort.The American journal of emergency medicine · 2026Observational
117 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundThe 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. METHODS AND
resultsAdult 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.
conclusionsThe 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. CLINICAL
trial registrationURL: http://www.clinicaltrials.gov. Unique Identifier: NCT01665521.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.