Evidence map›Paper›PMID 27183253›Full record

Trial reportCritical pathways in cardiology2016

Chest Pain Risk Stratification: A Comparison of the 2-Hour Accelerated Diagnostic Protocol (ADAPT) and the HEART Pathway.

Jason P Stopyra, Chadwick D Miller, Brian C Hiestand, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Robert F Riley, Gregory B Russell, Greg L Burke and 3 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical pathways in cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04381260 (RUral dispaRities in prehospitAL STEMI), which is not on this map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.1field-weighted citation impact, top 20% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT04381260 completednot on this mapstarted 2020, after this paper: background citation

RUral dispaRities in prehospitAL STEMI

Typeobservational_patient_registrySponsorWake Forest University Health SciencesRan2020 to 2022Enrolled473ConditionsST Elevation Myocardial Infarction, Cardiovascular DiseasesArmsNo intervention, Interview, Survey
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 19 citations in OpenAlex.

  1. Trial
  2. Article
  3. A Closer Look at the HEART Score.Cardiology research · 2022
    Review
  4. Article
  5. Article
  6. Observational
  7. Syncope Risk Stratification in the Emergency Department: Another Step Forward.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2016
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

Jason P StopyraFrom the *Department of Emergency Medicine, †Division of Cardiology, Department of Internal Medicine, ‡Department of Biostatistical Sciences, and §Department of Public Health, Wake Forest School of Medicine, Winston-Salem, NC.
Chadwick D Miller
Brian C Hiestand
Cedric W Lefebvre
Bret A Nicks
David M Cline
Kim L Askew
Robert F Riley
Gregory B Russell
Greg L Burke
David Herrington
James W Hoekstra
Simon A Mahler
Wake Forest University · US

Funding

Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
CMR-IMPACTR01HL118263 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI MILLER, CHADWICK DAVID · 2013 to 2018
$3.7M
NCATS NIH HHS UL1 TR001420NHLBI NIH HHS L30 HL120008NHLBI NIH HHS R01 HL118263
6 · The paper itself

Abstract

backgroundThe 2-hour accelerated diagnostic protocol (ADAPT) and the history electrocardiogram age risk factors troponin (HEART) Pathway are decision aids designed to identify Emergency Department (ED) patients with chest pain who are safe for early discharge. Both have demonstrated high sensitivity (>99%) for major adverse cardiac events (MACE) at 30 days and early discharge rates ≥20%. The objective of this study is to compare the sensitivity and early discharge rates of the ADAPT and HEART Pathway decision aids in a cohort of ED patients with acute chest pain.

methodsA secondary analysis of participants enrolled and randomized to the HEART Pathway arm of the HEART pathway randomized controlled trial was conducted. Each patient was prospectively classified as low risk (suitable for early discharge) or high risk by ADAPT and the HEART Pathway. Sensitivity for MACE at 30 days and the number of patients identified as low-risk were calculated for each decision aid. Decision aid performance was compared using McNemar's test.

resultsMACE occurred in 8 of 141 (5.7%); there were no deaths, 7 patients had myocardial infarction, and 1 patient had coronary revascularization without myocardial infarction. ADAPT and the HEART pathway identified all patients with MACE as high risk; sensitivity for MACE of 100% [95% confidence interval (CI): 63-100%]. ADAPT identified 34 of 141 patients (24%; 95% CI: 17-32%) as low-risk, whereas the Heart pathway identified 66 of 141 patients (47%, 95% CI: 38-55%) as low risk (P < 0.001).

conclusionsWithin a cohort of ED patients with acute chest pain, ADAPT and the HEART pathway had high sensitivity for MACE. The HEART pathway outperformed ADAPT by correctly identifying more patients as low risk and safe for early discharge.

Indexed as

Critical PathwaysDecision MakingEmergency Service, HospitalChest PainDiagnosis, DifferentialDiagnostic ImagingElectrocardiographyFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedNorth CarolinaReproducibility of ResultsRetrospective StudiesTroponin

Identifiers

PMID27183253
PMCPMC5172378
OpenAlexW2355788154

What OpenQuestion holds

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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.