ArticleCirculation2018
Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge.
Article in Circulation, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 90 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.
The HEART Pathway: Bridging the Gap Between Operations, Research, and Education
Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients (E-VICTORS) Project
Who cites it
90 citing papers in PubMed, 3 syntheses or guidelines pooled it, 163 citations in OpenAlex.
- The role of information systems in emergency department decision-making-a literature review.Journal of the American Medical Informatics Association : JAMIA · 2024Pooled it
- Pooled 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
- Cardiac magnetic resonance imaging reduces radiation exposure in emergency department patients with chest pain: A secondary analysis from the CMR IMPACT trial.The American journal of emergency medicine · 2026Trial
- Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial.European heart journal · 2023Trial
- Hospital Admission Despite Low-Risk History, Electrocardiogram, Age, Risk factors, and Troponin (HEART) Scores and 30-Day Outcomes in Emergency Department Chest Pain.Journal of the American College of Emergency Physicians 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
- Sex differences in acute chest pain care in a multisite U.S. emergency department cohort.The American journal of emergency medicine · 2026Observational
- Early Rule Out of Myocardial Infarction With a Novel High-Sensitivity Cardiac Troponin T Assay.JAMA cardiology · 2026Article
- [Advances in the application of the HEART score in patients with acute coronary syndromes].Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026Review
- Age Differences in Acute Chest Pain Care in a Multisite US Cohort.Clinical cardiology · 2026Observational
- Reducing Emergency Medical Services (EMS) Usage as Interfacility Transport for Patients Presenting with Chest Pain.Journal of clinical medicine · 2026Article
- Integration of focused cardiac ultrasound in the HEAR and HEART scores in emergency department patients with chest pain.Internal and emergency medicine · 2026Article
- Chest pain unit implementation in a multidisciplinary hospital: a retrospective observational study.Frontiers in cardiovascular medicine · 2026Article
- Use of machine learning for risk stratification of chest pain patients in the emergency department.BMC medical informatics and decision making · 2025Article
- Untreated Hypertension and Diabetes in the Chest Pain Observation Unit.The western journal of emergency medicine · 2025Observational
- Using Machine Learning to Risk Stratify Emergency Department Patients With Chest Pain but No Acute Myocardial Infarction: A Multicenter Retrospective Analysis.Journal of the American Heart Association · 2025Article
- Initiating Preventive Care for Hyperlipidemia in the Emergency Department: The Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders Trial.Critical pathways in cardiology · 2025Article
- Review
30 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
11 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe HEART Pathway (history, ECG, age, risk factors, and initial troponin) is an accelerated diagnostic protocol designed to identify low-risk emergency department patients with chest pain for early discharge without stress testing or angiography. The objective of this study was to determine whether implementation of the HEART Pathway is safe (30-day death and myocardial infarction rate <1% in low-risk patients) and effective (reduces 30-day hospitalizations) in emergency department patients with possible acute coronary syndrome.
methodsA prospective pre-post study was conducted at 3 US sites among 8474 adult emergency department patients with possible acute coronary syndrome. Patients included were ≥21 years old, investigated for possible acute coronary syndrome, and had no evidence of ST-segment-elevation myocardial infarction on ECG. Accrual occurred for 12 months before and after HEART Pathway implementation from November 2013 to January 2016. The HEART Pathway accelerated diagnostic protocol was integrated into the electronic health record at each site as an interactive clinical decision support tool. After accelerated diagnostic protocol integration, ED providers prospectively used the HEART Pathway to identify patients with possible acute coronary syndrome as low risk (appropriate for early discharge without stress testing or angiography) or non-low risk (appropriate for further in-hospital evaluation). The primary safety and effectiveness outcomes, death, and myocardial infarction (MI) and hospitalization rates at 30 days were determined from health records, insurance claims, and death index data.
resultsPreimplementation and postimplementation cohorts included 3713 and 4761 patients, respectively. The HEART Pathway identified 30.7% as low risk; 0.4% of these patients experienced death or MI within 30 days. Hospitalization at 30 days was reduced by 6% in the postimplementation versus preimplementation cohort (55.6% versus 61.6%; adjusted odds ratio, 0.79; 95% CI, 0.71-0.87). During the index visit, more MIs were detected in the postimplementation cohort (6.6% versus 5.7%; adjusted odds ratio, 1.36; 95% CI, 1.12-1.65). Rates of death or MI during follow-up were similar (1.1% versus 1.3%; adjusted odds ratio, 0.88; 95% CI, 0.58-1.33).
conclusionsHEART Pathway implementation was associated with decreased hospitalizations, increased identification of index visit MIs, and a very low death and MI rate among low-risk patients. These findings support use of the HEART Pathway to identify low-risk patients who can be safely discharged without stress testing or angiography. CLINICAL
trial registrationURL: http://www.clinicaltrials.gov . Unique identifier: NCT02056964.
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.