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

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials 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

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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.

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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。

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464