{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:38:23Z","timestamp":1793234303095,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\n              An interrupted time series study was conducted at 5 North Carolina sites in 26\u2005126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment\u2013elevation 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 \u03c7\n              <jats:sup>2<\/jats:sup>\n              tests and multivariable logistic regression to adjust for potential confounders.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Preimplementation and postimplementation cohorts included 12\u2005317 and 13\u2005809 patients, respectively, of them 52.7% (13\u2005767\/26\u2005126) were female with a median age of 54 years (interquartile range, 42\u201366). Rates of 30-day death or MI were 6.8% (945\/13\u2005809) postimplementation and 7.7% (948\/12\u2005317) preimplementation (adjusted odds ratio, 1.00 [95% CI, 0.90\u20131.11]). hs-HP implementation was associated with 19.9% (95% CI, 18.7%\u201321.1%) higher early discharges (post versus pre: 63.6% versus 43.7%; adjusted odds ratio, 2.22 [95% CI, 2.10\u20132.35]). The hs-HP was also associated with 16.1% (95% CI, 14.9%\u201317.3%) lower 30-day hospitalizations (postimplementation versus preimplementation, 31.4% versus 47.5%; adjusted odds ratio, 0.51 [95% CI, 0.48\u20130.54]). Among early discharge patients, death or myocardial infarction occurred in 0.5% (41\/8780) postimplementation versus 0.4% (22\/5383) preimplementation (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.61).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>hs-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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.010270","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T10:00:47Z","timestamp":1707386447000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2199-4078","authenticated-orcid":true,"given":"Simon A.","family":"Mahler","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."},{"name":"Department of Implementation Science (S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."},{"name":"Department of Epidemiology and Prevention (S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-8813","authenticated-orcid":true,"given":"Nicklaus P.","family":"Ashburn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."},{"name":"Section on Cardiovascular Medicine, Department of Internal Medicine (N.P.A.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6008-6096","authenticated-orcid":true,"given":"Brennan E.","family":"Paradee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7457-3969","authenticated-orcid":true,"given":"Jason P.","family":"Stopyra","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna C.","family":"Snavely","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."},{"name":"Department of Biostatistics and Data Science (A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_3_3_3_2","unstructured":"Survey NHAMC. 2015 emergency department summary tables. http:\/\/www.cdc.gov\/nchs\/data\/ahcd\/nhamcs_emergency\/2010_ed_web_tables.pdf.: CDC; 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