Abstract 15353: The HEART Pathway Randomized Trial: Identifying Emergency Department Patients with Acute Chest Pain for Early Discharge
Introduction: The HEART Pathway is a decision aid designed to identify emergency department (ED) patients with acute chest pain for early discharge. This trial compares the efficacy of the HEART Pathway versus usual care (UC) for ED chest pain risk stratification.
Hypothesis: The HEART Pathway will increase the early discharge rate of ED patients with chest pain by ≤20% compared to UC without missing major adverse cardiac events (MACE) at 30 days.
Methods: Adult ED patients with chest pain concerning for acute coronary syndrome without ST-elevation on initial electrocardiogram were randomized to the HEART pathway or UC (based on ACC/AHA guidelines). In the HEART Pathway arm, ED providers used the HEART Score, a validated risk stratification tool, and troponins at 0 and 3 hours to identify patients for early discharge. Outcomes included rate of early discharge (ED discharge without objective testing), rate of objective cardiac testing (stress testing or angiography), index hospital length of stay (LOS), and MACE: death, myocardial infarction, and coronary revascularization during the index visit and 30 day follow-up period.
Results: From 9/2012-2/2014, 282 patients with symptoms suggestive of ACS were enrolled, with 141 randomized to each treatment arm. Compared to UC, use of the HEART Pathway increased early discharge by 21.3% (39.7% vs 18.4%, p<0.001), decreased objective cardiac testing at 30 days by 12.1% (68.8% vs 56.7%, p=0.048), and decreased median LOS by 12 hours (9.9 vs 21.9 hours, p=0.013). No patients identified for early discharge had MACE within the 30 day follow up period.
Conclusions: The HEART Pathway produced meaningful reductions in healthcare utilization outcomes: reducing objective cardiac testing rates, cutting index LOS by 12 hours, and increasing the early discharge rate by over 20%. These important efficiency gains were accomplished without any 30 day MACE events occurring among patients identified for early discharge.
Author Disclosures: S.A. Mahler: Research Grant; Significant; American Heart Association, Association of American Medical Colleges/Donaghue Foundation, NHLBI. R.F. Riley: Research Grant; Significant; American Heart Association. B.C. Hiestand: None. G. Russell: None. J.W. Hoekstra: None. C.W. Lefebvre: None. B.A. Nicks: None. D.M. Cline: None. K.L. Askew: None. S.B. Elliott: Research Grant; Significant; American Heart Association. D.M. Herrington: Research Grant; Significant; American Heart Association, NHLBI. G.L. Burke: None. C.D. Miller: Research Grant; Significant; NHLBI.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.