Trial reportAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2019
The HEART Pathway Randomized Controlled Trial One-year Outcomes.
Trial report in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04617834 (Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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.
Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients (E-VICTORS) Project
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 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
- Artificial Intelligence-Driven Cost Savings from Emergency Department Chest Pain Patient Evaluation: A Monte Carlo Simulation.The western journal of emergency medicine · 2026Article
- Article
- Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score.Open heart · 2024Article
- 2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024Article
- Rural and socioeconomic differences in the effectiveness of the HEART Pathway accelerated diagnostic protocol.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2023Article
- A novel cardiovascular risk assessment tool for the prediction of myocardial ischemia on imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Article
- Age differences in the safety and effectiveness of the HEART Pathway accelerated diagnostic protocol for acute chest pain.Journal of the American Geriatrics Society · 2022Article
- Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Article
- Article
- Scoring systems for the triage and assessment of short-term cardiovascular risk in patients with acute chest pain.Reviews in cardiovascular medicine · 2021Review
- Validation and modification of HEART score components for patients with chest pain in the emergency department.Clinical and experimental emergency medicine · 2021Article
- Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021.Arquivos brasileiros de cardiologia · 2021 · on this mapArticle
- The disutility of stress testing in low-risk HEART Pathway patients.The American journal of emergency medicine · 2021Article
- Not all HEART scores are created equal: identifying "low-risk" patients at higher risk.Journal of the American College of Emergency Physicians open · 2020Article
- HEART Pathway Implementation Safely Reduces Hospitalizations at One Year in Patients With Acute Chest Pain.Annals of emergency medicine · 2020Article
- Real-time AI prediction for major adverse cardiac events in emergency department patients with chest pain.Scandinavian journal of trauma, resuscitation and emergency medicine · 2020Article
Corrections and comments
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Authors and funding
14 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThe objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain.
methodsAdult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE-cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests.
resultsA total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low-risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%-100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac-related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36).
conclusionsThe HEART Pathway had a 100% NPV for 1-year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1-year objective testing was not significant.
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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.