Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2017
Validation of the No Objective Testing Rule and Comparison to the HEART Pathway.
Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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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.
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Who cites it
6 citing papers in PubMed.
- The HEART Pathway Randomized Controlled Trial One-year Outcomes.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Trial
- The HEART score has less utility with high sensitivity troponin.Frontiers in cardiovascular medicine · 2026Article
- Characterizing pre-discharge interventions to reduce length of stay for older adults: A scoping review.PloS one · 2025Article
- A Closer Look at the HEART Score.Cardiology research · 2022Review
- Appropriateness of Cardiovascular Imaging in the Initial Assessment of Possible Acute Coronary Syndrome in the Emergency Department.Reviews in cardiovascular medicine · 2022Review
- Prehospital use of a modified HEART Pathway and point-of-care troponin to predict cardiovascular events.PloS one · 2020Article
Corrections and comments
- Commented on byIn Reply.2017
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Authors and funding
11 authors.
Funding
Abstract
backgroundThe no objective testing rule (NOTR) is a decision aid designed to safely identify emergency department (ED) patients with chest pain who do not require objective testing for coronary artery disease.
objectivesThe objective was to validate the NOTR in a cohort of U.S. ED patients with acute chest pain and compare its performance to the HEART Pathway.
methodsA secondary analysis of 282 participants enrolled in the HEART Pathway randomized controlled trial was conducted. Each patient was classified as low risk or at risk by the NOTR. Sensitivity for major adverse cardiac events (MACE) at 30 days was calculated in the entire study population. NOTR and HEART Pathways were compared among patients randomized to the HEART Pathway in the parent trial using McNemar's test and the net reclassification improvement (NRI).
resultsMajor adverse cardiac events occurred in 22/282 (7.8%) participants, including no deaths, 16/282 (5.6%) with myocardial infarction (MI), and 6/282 (2.1%) with coronary revascularization without MI. NOTR was 100% (95% confidence interval [CI] = 84.6%-100%) sensitive for MACE and identified 78/282 patients (27.7%, 95% = CI 22.5-33.3%) as low risk. In the HEART Pathway arm (n = 141), both NOTR and HEART Pathway identified all patients with MACE as at risk. Compared to NOTR, the HEART Pathway was able to correctly reclassify 27 patients without MACE as low risk, yielding a NRI of 20.8% (95% CI = 11.3%-30.2%).
conclusionsWithin a U.S. cohort of ED patients with chest pain, the NOTR and HEART Pathway were 100% sensitive for MACE at 30 days. However, the HEART Pathway identified more patients suitable for early discharge than the NOTR.
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