ArticleCirculation. Cardiovascular quality and outcomes2024
Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome.
Article in Circulation. Cardiovascular quality and outcomes, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Validation of a 0/2-Hour Point-Of-Care High Sensitivity Troponin Algorithm: A Multisite US Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Analytical and Workflow Performance of a High-Throughput Chemiluminescent Immunoassay System in a Clinical Laboratory.Journal of clinical laboratory analysis · 2026Article
- 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
- Evaluating the Efficacy of CPS, HEART and TIMI Score in Emergency Department Patients with Non-Traumatic Chest Pain: A Pilot Study.Medical sciences (Basel, Switzerland) · 2026Article
- Article
- Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts.Open heart · 2025Article
- Assessing modified HEART scores with high-sensitivity troponin for low-risk chest pain in the emergency department.Internal and emergency medicine · 2025Observational
- Performance of the High-STEACS Early Rule Out Pathway Using hs-cTnT at 30 Days in a Multisite US Cohort.Circulation. Cardiovascular quality and outcomes · 2025Observational
- Sex-specific high-sensitivity troponin T cut-points have similar safety but lower efficacy than overall cut-points in a multisite U.S. cohort.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Observational
- The High-Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort.Clinical cardiology · 2024Article
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6 authors.
Funding
Abstract
backgroundThe HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. However, data on whether a high-sensitivity HEART Pathway (hs-HP) are safe and effective is lacking.
methodsAn interrupted time series study was conducted at 5 North Carolina sites in 26 126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment-elevation myocardial infarction. Patients were accrued into 16-month preimplementation and postimplementation cohorts with a 6-month wash-in phase. Preimplementation (January 2019 to April 2020), the traditional HEART Pathway was used with 0- and 3-hour contemporary troponin measures (Siemens). In the postimplementation period (November 2020 to February 2022), a modified hs-HP was used with 0- and 2-hour high-sensitivity cardiac troponin (Beckman Coulter) measures. The primary safety and effectiveness outcomes were 30-day all-cause death or myocardial infarction and 30-day hospitalizations. These outcomes and early discharge rate (emergency department discharge without stress testing or coronary angiography) were determined from health records and death index data. Outcomes were compared preimplementation versus postimplementation using χ
resultsPreimplementation and postimplementation cohorts included 12 317 and 13 809 patients, respectively, of them 52.7% (13 767/26 126) were female with a median age of 54 years (interquartile range, 42-66). Rates of 30-day death or MI were 6.8% (945/13 809) postimplementation and 7.7% (948/12 317) preimplementation (adjusted odds ratio, 1.00 [95% CI, 0.90-1.11]). hs-HP implementation was associated with 19.9% (95% CI, 18.7%-21.1%) higher early discharges (post versus pre: 63.6% versus 43.7%; adjusted odds ratio, 2.22 [95% CI, 2.10-2.35]). The hs-HP was also associated with 16.1% (95% CI, 14.9%-17.3%) lower 30-day hospitalizations (postimplementation versus preimplementation, 31.4% versus 47.5%; adjusted odds ratio, 0.51 [95% CI, 0.48-0.54]). Among early discharge patients, death or myocardial infarction occurred in 0.5% (41/8780) postimplementation versus 0.4% (22/5383) preimplementation (
conclusionshs-HP implementation is associated with increased early discharges without increasing adverse events. These findings support the use of a modified hs-HP to improve chest pain care.
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