ArticleJournal of the American Geriatrics Society2022
Age differences in the safety and effectiveness of the HEART Pathway accelerated diagnostic protocol for acute chest pain.
Article in Journal of the American Geriatrics Society, 2022. 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, 12 citations in OpenAlex.
- Sex differences in acute chest pain care in a multisite U.S. emergency department cohort.The American journal of emergency medicine · 2026Observational
- Age Differences in Acute Chest Pain Care in a Multisite US Cohort.Clinical cardiology · 2026Observational
- An easy-to-use model for screening type 2 myocardial infarction in geriatric patients with acute coronary syndrome: a retrospective cohort study.Frontiers in medicine · 2026Article
- HEART Score and Its Implementation in Emergency Medicine Departments in the West Balkan Region-A Pilot Study.Healthcare (Basel, Switzerland) · 2023Article
- 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
- 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
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe HEART Pathway is a validated protocol for risk stratifying emergency department (ED) patients with possible acute coronary syndrome (ACS). Its performance in different age groups is unknown. The objective of this study is to evaluate its safety and effectiveness among older adults.
methodsA pre-planned subgroup analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time series accrued adult ED patients with possible ACS who were without ST-elevation across three US sites from 11/2013-01/2016. After implementation, providers prospectively used the HEART Pathway to stratify patients as low-risk or non-low-risk. Patients were classified as older adults (≥65 years), middle-aged (46-64 years), and young (21-45 years). Primary safety and effectiveness outcomes were 30-day death or MI and hospitalization at 30 days, determined from health records, insurance claims, and death index data. Fisher's exact test compared low-risk proportions between groups. Sensitivity for 30-day death or MI and adjusted odds ratios (aORs) for hospitalization and objective cardiac testing were calculated.
resultsThe HEART Pathway implementation study accrued 8474 patients, of which 26.9% (2281/8474) were older adults, 45.5% (3862/8474) middle-aged, and 27.5% (2331/8474) were young. The HEART Pathway identified 7.4% (97/1303) of older adults, 32.0% (683/2131) of middle-aged, and 51.4% (681/1326) of young patients as low-risk (p < 0.001). The HEART Pathway was 98.8% (95% CI 97.1-100) sensitive for 30-day death or MI among older adults. Following implementation, the rate of 30-day hospitalization was similar among older adults (aOR 1.25, 95% CI 1.00-1.55) and cardiac testing increased (aOR 1.25, 95% CI 1.04-1.51).
conclusionThe HEART Pathway identified fewer older adults as low-risk and did not decrease hospitalizations in this age group.
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