Does the HEART Pathway identify patients at low risk of a major adverse cardiac event at 1-year without increasing health care utilization?

BEEM Bottom Line

Why is this study important?

Chest pain is one of the most common presenting symptoms seen in the emergency department (ED). Decreasing the number of patients who undergo stress testing or cardiac imaging could lead to a decrease in false positive tests. False positives increase the overall cost to the system and expose patients to unnecessary risks during invasive testing such as angiography. A pathway that could safely and reliably identify patients who do not require further evaluation will save time and money for both the health system and the patient. The HEART Pathway combines the HEART score with serial cardiac troponin measurements for ED patients with suspected acute coronary syndrome (ACS). This analysis was to determine whether patients identified as low-risk by the HEART Pathway (defined as HEART score 0–3 and negative troponins at 0- and 3-hours) would have a 1-year major adverse cardiac event (MACE) rate of < 1% without increase in health care utilization.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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