The HEART Pathway Randomized Controlled Trial One‐year Outcomes

Abstract

The HEART Pathway had a 100% NPV for 1-year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1-year objective testing was not significant.

Real-time AI prediction for major adverse cardiac events in emergency department patients with chest pain

“…The 14 feature variables recruited for the analyzes were the suggested predictors of MACE in previous studies as follows [5,6,14]: age, sex, smoking, body mass index (BMI), and past histories of hypertension (ICD-9-CM: 401-405 or ICD-10: I10-I16), hyperlipidemia (ICD-9-CM: 272.0-272.5, 277.7 or ICD-10: E78.0-E78.5, E88.81), diabetes (ICD-9-CM: 250 or ICD-10: E08-E13), chronic kidney disease (ICD-9-CM: 585 or ICD-10: N18), coronary artery disease (ICD-9-CM: 410-414 or ICD-10: I20-I25), cerebrovascular diseases (ICD-9-CM: 430-438 or ICD-10: I60-I69, G45), peripheral artery occlusive disease (ICD-9-CM: 443.9 or ICD-10: I73.9), and last laboratory data including high sensitive troponin-I, hemoglobin, and serum creatinine. The last high sensitive troponin-I is automatically captured into the AI prediction model when the ED physician pushes the AI button in the HIS when they need assistance.…”

“…The original risk stratifications and suggested dispositions according to HEART score are as follows: (1) 0–3 points (2.5% for major adverse cardiac events [MACE]): an immediate discharge; 4–6 points (20.3% for MACE): implies hospitalization for clinical observation; and (3) ≥7 points: (72.7% for MACE): early invasive strategies [ 4 ]. The HEART score has the advantages of high accuracy and has been well-validated in many studies [ 5 – 7 ]. The disadvantage of the HEART score is that it takes time to calculate for prediction; even a calculator is available online [ 8 ], which limits its use in the over-crowded ED.…”

Not all HEART scores are created equal: identifying “low‐risk” patients at higher risk

“…Prior studies of the HEART score have recognized the elevated risk associated with elevated troponin values by excluding patients with any troponin abnormality on a conventional cardiac troponin assay (essentially reverting to an HEAR score that cannot risk stratify patients with slightly elevated troponins). 8 Meanwhile, some decision tools, such as the T-MACS score, use precise values from highsensitivity troponin assays to generate continuous risk estimates from, but are too complex to compute without integrated electronic decision support tools. 9 This study attempts to combine these approaches by leveraging the existing HEART score to identify patients who may be at higher risk.…”

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021

“…109 Estudo que comparou de forma randomizada a aplicação do escore HEART no fluxo de atendimento emergencial de pacientes com dor torácica verificou um elevado valor preditivo negativo para ocorrência de eventos cardiovasculares maiores no primeiro ano, sem diferenças observadas quanto à internação hospitalar ou readmissão em serviço de emergência. 110 Neste sentido, o atual impacto da avaliação adicional rotineira por exames de imagem em paciente classificados como baixo risco tem sido reconsiderado, pois, apesar do reconhecido valor quanto à redução do tempo para o diagnóstico, evidências atuais identificaram que essa estratégia pode proporcionar um aumento de exames adicionais sem benefício verificado quanto à ocorrência de IAM ou eventos clínicos relevantes. 111…”