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

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2024-10-17 DOI:10.1002/clc.70027

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

{"title":"The High-Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort","authors":"Campbell J. Veasey, Anna C. Snavely, Zechariah L. Kearns, Nicklaus P. Ashburn, Tara Hashemian, Simon A. Mahler","doi":"10.1002/clc.70027","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The 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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-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 (<i>p</i> < 0.001). Additionally, 47.3% of males and 54.4% of females were ruled-out (<i>p</i> < 0.001). Among rule-out patients, 0.3% of White versus 0.3% of non-White patients (<i>p</i> = 0.98) and 0.3% of females versus males 0.3% (<i>p</i> = 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 (<i>p</i> = 0.10) and sex (<i>p</i> = 0.69) were not significant.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The 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.</p>\n </section>\n </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 10","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70027","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Cardiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/clc.70027","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The 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.

Methods

We 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.

Results

Twenty-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.

Conclusions

The 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.

查看原文本刊更多论文

在美国多地点前瞻性队列中，无论性别或种族如何，高灵敏度 HEART 途径都能安全地降低住院率

背景高灵敏度心血管病路径（hs-HP）可对急诊科（ED）胸痛患者进行风险分层。其安全性和有效性是否因性别或种族而异尚属未知。方法我们对 hs-HP 实施研究进行了亚组分析，这是一项在美国五家急诊室进行的前后间断时间序列研究。实施前（2019 年 1 月至 2020 年 4 月）采用传统 HEART 路径和当代肌钙蛋白（西门子），实施后（2020 年 11 月至 2022 年 2 月）采用 hs-HP 和 hs-cTnI（贝克曼库尔特）。使用 hs-HP 对患者进行风险分层，分为排除组、观察组和纳入组。安全性和有效性结果为 30 天全因死亡率或心肌梗死（MI）和 30 天住院率。结果共招募了 2.6126 万名患者（实施前为 12 317 人，实施后为 13 809 人），其中 35.3% 为非白人，52.7% 为女性。在完成 hs-HP 评估的 9703 名患者中，48.6% 的白人和 55.4% 的非白人患者被排除在外（p <0.001）。此外，47.3% 的男性和 54.4% 的女性被排除在外（p < 0.001）。在被排除的患者中，有 0.3% 的白人患者和 0.3% 的非白人患者（P = 0.98）以及 0.3% 的女性患者和 0.3% 的男性患者（P = 0.90）经历了 30 天死亡或心肌梗死。实施后，白人患者的 30 天住院率下降了 17.2%（aOR 0.49，95% CI：0.45-0.52），非白人患者下降了 14.1%（aOR 0.53，95% CI：0.48-0.59），女性下降了 15.6%（aOR 0.50，95% CI：0.46-0.54），男性下降了 16.6%（aOR 0.51，95% CI：0.47-0.56）。实施 hs-HP 与种族（p = 0.10）和性别（p = 0.69）之间的 30 天住院交互作用不显著。结论无论性别或种族如何，hs-HP 都能安全地降低 30 天住院率。但是，它将更多的非白人患者和女性归入排除组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.