Evidence map›Paper›PMID 39417405›Full record

ArticleClinical cardiology2024

The High-Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort.

Campbell J Veasey, Anna C Snavely, Zechariah L Kearns, Nicklaus P Ashburn, Tara Hashemian, Simon A Mahler

Abstract readMulticenter Study
In one paragraph

Article in Clinical cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Observational
  2. Observational
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Campbell J VeaseyDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.
Anna C SnavelyDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.
Zechariah L KearnsDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.
Nicklaus P AshburnDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.ORCID http://orcid.org/0000-0002-3466-8813
Tara HashemianDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.
Simon A MahlerDepartment of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, North Carolina, USA.

Funding

Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
NCATS NIH HHS UL1 TR001420This study was supported by the National Center for Advancing Translational Sciences, Grant/Award Number: UL1TR001420.
6 · The paper itself

Abstract

backgroundThe high-sensitivity HEART pathway (hs-HP) risk stratifies emergency department (ED) patients with chest pain. It is unknown if its safety and effectiveness vary by sex or race.

methodsWe conducted a subgroup analysis of the hs-HP implementation study, a pre-post interrupted time series at five US EDs. The pre-implementation period (January 2019 to April 2020) utilized the traditional HEART pathway with contemporary troponin (Siemens) and the post-implementation period (November 2020 to February 2022) used the hs-HP using hs-cTnI (Beckman Coulter). Patients were risk-stratified using the hs-HP to rule-out, observation, and rule-in groups. Safety and effectiveness outcomes were 30-day all-cause mortality or myocardial infarction (MI) and 30-day hospitalization.

resultsTwenty-six thousand and one hundred twenty-six patients were accrued (12 317 pre- and 13 809 post-implementation), of which 35.3% were non-White and 52.7% were female. Among 9703 patients with complete hs-HP assessments, 48.6% of White and 55.4% of non-White patients were ruled-out (p < 0.001). Additionally, 47.3% of males and 54.4% of females were ruled-out (p < 0.001). Among rule-out patients, 0.3% of White versus 0.3% of non-White patients (p = 0.98) and 0.3% of females versus males 0.3% (p = 0.90) experienced 30-day death or MI. Post-implementation, 30-day hospitalization decreased 17.2% among White patients (aOR 0.49, 95% CI: 0.45-0.52), 14.1% among non-White patients (aOR 0.53, 95% CI: 0.48-0.59), 15.6% among females (aOR 0.50, 95% CI: 0.46-0.54), and 16.6% among males (aOR 0.51, 95% CI: 0.47-0.56). The interactions for 30-day hospitalization between hs-HP implementation and race (p = 0.10) and sex (p = 0.69) were not significant.

conclusionsThe hs-HP safely decreases 30-day hospitalizations regardless of sex or race. However, it classifies more non-White patients and women to the rule-out group.

Indexed as

Emergency Service, HospitalHospitalizationAgedBiomarkersChest PainCritical PathwaysFemaleHumansMaleMiddle AgedMyocardial InfarctionProspective StudiesRace FactorsRisk AssessmentRisk FactorsSex FactorsBiomarkerschest paindisparitiesHEART pathwayhigh‐sensitivity cardiac troponinracerisk stratificationsex

Identifiers

PMID39417405
PMCPMC11483562

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Registered trials

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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.