Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test
The study aims to develop a decision pathway based on HEAR score and 0 h high-sensitivity cardiac troponin T (hs-cTnT) to safely avoid a second troponin test for suspected non-ST elevation myocardial infarction (NSTEMI) in emergency departments. A HEAR score consists of history, electrocardiogram, a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/20/3217 |
| _version_ | 1797574117740773376 |
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| author | Chen Chen Yao Yu Dongxu Chen Canguang Cai Yannan Zhou Fengqing Liao Alima Humarbek Xuan Li Zhenju Song Zhan Sun Chaoyang Tong Chenling Yao Guorong Gu |
| author_facet | Chen Chen Yao Yu Dongxu Chen Canguang Cai Yannan Zhou Fengqing Liao Alima Humarbek Xuan Li Zhenju Song Zhan Sun Chaoyang Tong Chenling Yao Guorong Gu |
| author_sort | Chen Chen |
| collection | DOAJ |
| description | The study aims to develop a decision pathway based on HEAR score and 0 h high-sensitivity cardiac troponin T (hs-cTnT) to safely avoid a second troponin test for suspected non-ST elevation myocardial infarction (NSTEMI) in emergency departments. A HEAR score consists of history, electrocardiogram, age, and risk factors. A HEAR pathway is established using a Bayesian approach based on a predefined safety threshold of NSTEMI prevalence in the rule-out group. In total, 7131 patients were retrospectively enrolled, 582 (8.2%) with index visit NSTEMI and 940 (13.2%) with 180-day major adverse cardiovascular events (MACE). For patients with a low-risk HEAR score (0 to 2) and low 0 h hs-cTnT (<14 ng/L), the HEAR pathway recommends early discharge without further testing. After the HEAR pathway had been applied to rule out NSTEMI, the negative predictive value of index visit NSTEMI was 100.0% (95% CI, 99.8% to 100.0%) and false-negative rate of 180-day MACE was 0.40% (95% CI, 0.18% to 0.87%). Compared with the 0 h hs-cTnT < limit of detection (LoD) strategy (<5 ng/L), the HEAR pathway could correctly reclassify 1298 patients without MACE as low risk and lead to a 18.2% decrease (95% CI, 17.4–19.1%) in the need for a second troponin test. The HEAR pathway may lead to a substantial and safe reduction in repeated troponin test for emergency department patients with suspected NSTEMI. |
| first_indexed | 2024-03-10T21:18:20Z |
| format | Article |
| id | doaj.art-23b32f3dd197408e80837da7d8f5693f |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T21:18:20Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-23b32f3dd197408e80837da7d8f5693f2023-11-19T16:12:56ZengMDPI AGDiagnostics2075-44182023-10-011320321710.3390/diagnostics13203217Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin TestChen Chen0Yao Yu1Dongxu Chen2Canguang Cai3Yannan Zhou4Fengqing Liao5Alima Humarbek6Xuan Li7Zhenju Song8Zhan Sun9Chaoyang Tong10Chenling Yao11Guorong Gu12Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaDepartment of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaThe study aims to develop a decision pathway based on HEAR score and 0 h high-sensitivity cardiac troponin T (hs-cTnT) to safely avoid a second troponin test for suspected non-ST elevation myocardial infarction (NSTEMI) in emergency departments. A HEAR score consists of history, electrocardiogram, age, and risk factors. A HEAR pathway is established using a Bayesian approach based on a predefined safety threshold of NSTEMI prevalence in the rule-out group. In total, 7131 patients were retrospectively enrolled, 582 (8.2%) with index visit NSTEMI and 940 (13.2%) with 180-day major adverse cardiovascular events (MACE). For patients with a low-risk HEAR score (0 to 2) and low 0 h hs-cTnT (<14 ng/L), the HEAR pathway recommends early discharge without further testing. After the HEAR pathway had been applied to rule out NSTEMI, the negative predictive value of index visit NSTEMI was 100.0% (95% CI, 99.8% to 100.0%) and false-negative rate of 180-day MACE was 0.40% (95% CI, 0.18% to 0.87%). Compared with the 0 h hs-cTnT < limit of detection (LoD) strategy (<5 ng/L), the HEAR pathway could correctly reclassify 1298 patients without MACE as low risk and lead to a 18.2% decrease (95% CI, 17.4–19.1%) in the need for a second troponin test. The HEAR pathway may lead to a substantial and safe reduction in repeated troponin test for emergency department patients with suspected NSTEMI.https://www.mdpi.com/2075-4418/13/20/3217HEAR pathwayhigh-sensitivity cardiac troponinnon-ST elevation myocardial infarctionemergency departmentchest pain |
| spellingShingle | Chen Chen Yao Yu Dongxu Chen Canguang Cai Yannan Zhou Fengqing Liao Alima Humarbek Xuan Li Zhenju Song Zhan Sun Chaoyang Tong Chenling Yao Guorong Gu Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test Diagnostics HEAR pathway high-sensitivity cardiac troponin non-ST elevation myocardial infarction emergency department chest pain |
| title | Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test |
| title_full | Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test |
| title_fullStr | Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test |
| title_full_unstemmed | Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test |
| title_short | Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test |
| title_sort | derivation of a hear pathway for emergency department chest pain patients to safely avoid a second troponin test |
| topic | HEAR pathway high-sensitivity cardiac troponin non-ST elevation myocardial infarction emergency department chest pain |
| url | https://www.mdpi.com/2075-4418/13/20/3217 |
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