Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2016
Adherence to an Accelerated Diagnostic Protocol for Chest Pain: Secondary Analysis of the HEART Pathway Randomized Trial.
Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed.
- Predictive Performance of the HEART Score for Acute Coronary Syndrome with Significant Coronary Stenosis in Patients with Non-ST-Elevation Acute Chest Pain.Journal of cardiovascular development and disease · 2026Article
- Adherence to Accelerated Diagnostic Protocol for Chest Pain in Five Emergency Departments in Canada.The western journal of emergency medicine · 2025Article
- Cost-Effectiveness of the CADScor System in Low-Risk Patients Presenting to the Emergency Department with Chest Pain.PharmacoEconomics - open · 2025Article
- Utilization and outcomes of single-troponin discharge from the emergency department in a low-risk population.Global cardiology science & practice · 2025Article
- Characterizing pre-discharge interventions to reduce length of stay for older adults: A scoping review.PloS one · 2025Article
- Target Heart Rate Formulas for Exercise Stress Testing: What Is the Evidence?Journal of clinical medicine · 2024Review
- Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome.Circulation. Cardiovascular quality and outcomes · 2024Article
- Practice and Evaluation of a Protocol for Collating Information Related to the Emergency Clinical Pathway for Patients With Acute ST-Segment Elevation Myocardial Infarction.Frontiers in cardiovascular medicine · 2022Article
- A Prospective Evaluation of Clinical HEART Score Agreement, Accuracy, and Adherence in Emergency Department Chest Pain Patients.Annals of emergency medicine · 2021Observational
- Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Article
- The disutility of stress testing in low-risk HEART Pathway patients.The American journal of emergency medicine · 2021Article
- Identification of very low-risk acute chest pain patients without troponin testing.Emergency medicine journal : EMJ · 2020Article
- Use of conventional cardiac troponin assay for diagnosis of non-ST-elevation myocardial infarction: 'The Ottawa Troponin Pathway'.PloS one · 2020Article
- Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge.Circulation · 2018Article
- Implementation of an Opioid Detoxification Management Pathway Reduces Emergency Department Length of Stay.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2018Article
- The HEART Pathway and Hospital Cost Savings.Critical pathways in cardiology · 2017Article
- Comparison of 3 Symptom Classification Methods to Standardize the History Component of the HEART Score.Critical pathways in cardiology · 2017Article
- Systematic review of the effects of care provided with and without diagnostic clinical prediction rules.Diagnostic and prognostic research · 2017Review
- Implementation of a Risk Stratification and Management Pathway for Acute Chest Pain in the Emergency Department.Critical pathways in cardiology · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
Abstract
objectivesAccelerated diagnostic protocols (ADPs), such as the HEART Pathway, are gaining popularity in emergency departments (EDs) as tools used to risk stratify patients with acute chest pain. However, provider nonadherence may threaten the safety and effectiveness of ADPs. The objective of this study was to determine the frequency and impact of ADP nonadherence.
methodsA secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. This trial enrolled 282 adult ED patients with symptoms concerning for acute coronary syndrome without ST-elevation on electrocardiogram. Patients randomized to the HEART Pathway (N = 141) were included in this analysis. Outcomes included index visit disposition, nonadherence, and major adverse cardiac events (MACEs) at 30 days. MACE was defined as death, myocardial infarction, or revascularization. Nonadherence was defined as: 1) undertesting-discharging a high-risk patient from the ED without objective testing (stress testing or coronary angiography) or 2) overtesting-admitting or obtaining objective testing on a low-risk patient.
resultsNonadherence to the HEART Pathway occurred in 28 of 141 patients (20%, 95% confidence interval [CI] = 14% to 27%). Overtesting occurred in 19 of 141 patients (13.5%, 95% CI = 8% to 19%) and undertesting in nine of 141 patients (6%, 95% CI = 3% to 12%). None of these 28 patients suffered MACE. The net effect of nonadherence was 10 additional admissions among patients identified as low-risk and appropriate for early discharge (absolute decrease in discharge rate of 7%, 95% CI = 3% to 13%).
conclusionsReal-time use of the HEART Pathway resulted in a nonadherence rate of 20%, mostly due to overtesting. None of these patients had MACE within 30 days. Nonadherence decreased the discharge rate, attenuating the HEART Pathway's impact on health care use.
Indexed as
Identifiers
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.