2017
DOI: 10.1016/j.clinbiochem.2017.01.003
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Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Abstract: Objectives The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve >99% sensitivity for major adverse cardiac events (MACE) at 30 days and early discharge rates >20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & Methods A secondary analysis of participants enrol… Show more

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Cited by 26 publications
(16 citation statements)
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“…This assessment could feasibly be carried out in primary care, but would need resourced, secondary care support and robust evaluation. [47][48][49] Paramedics can use the HEAR score to discriminate risk, but even when used in combination with out-of-hospital point-of-care cardiac-troponin-level testing, the HEART score does not safely rule out major adverse cardiac events, and only a small proportion of patients are identified as high risk.…”
Section: Discussionmentioning
confidence: 99%
“…This assessment could feasibly be carried out in primary care, but would need resourced, secondary care support and robust evaluation. [47][48][49] Paramedics can use the HEAR score to discriminate risk, but even when used in combination with out-of-hospital point-of-care cardiac-troponin-level testing, the HEART score does not safely rule out major adverse cardiac events, and only a small proportion of patients are identified as high risk.…”
Section: Discussionmentioning
confidence: 99%
“…The HEART Pathway risk assessment was automatically calculated based on the HEAR score and 0 and 3-hour troponin measures. 13, 23 Patients with HEAR scores of 3 or lower and without elevated troponin measures were classified as low-risk and recommended for discharge from the ED without objective cardiac testing. Patients with a HEAR score of 4 greater, an elevated troponin, known CAD, or ischemic ECG changes were classified as non-low-risk and designated for further testing and/or admission (Figure 1).…”
Section: Methodsmentioning
confidence: 99%
“…21 Further improvement of the diagnostic accuracy can probably be achieved by modifying the HEART score to incorporate serial troponin measurements. 2224…”
Section: Discussionmentioning
confidence: 99%