From the Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Crit Pathw Cardiol. 2022 Mar 1;21(1):7-10. doi: 10.1097/HPC.0000000000000254.
Data evaluating the impact of the history, ECG, age, risk factors, and troponin (HEART) Pathway on observation unit (OU) use is limited. The objective of this study is to determine how HEART Pathway implementation affects OU use.
An analysis of OU registry data from October 2012 to October 2016, 2 years before and after HEART Pathway implementation at an academic medical center, was conducted. Adult patients placed in the OU for chest pain were included. The proportion of patients placed in the OU chest pain protocol per total OU volume and hospitalization and myocardial infarction (MI) rates were determined. Proportions before versus after implementation were compared using χ2 tests and age was compared using a Mann-Whitney U test.
During the study period, 1688 patients with chest pain before HEART Pathway implementation and 1692 after were included. The proportion of chest pain patients in the OU per total OU volume decreased following implementation from (57% [1688/2968] to 43.6% [1692/3882]; P < 0.001). Before HEART Pathway implementation, the hospitalization rate was 10.4% (175/1688) versus 12.4% (210/1692) after (P = 0.07). More patients were diagnosed with MI following implementation (0.8% [14/1665] vs. 2.0% [33/1686]; P = 0. 008). Median age was older postimplementation (52 years [IQR: 45-59 years] vs. 54 years [IQR: 48-64 years]; P < 0. 001).
HEART Pathway implementation resulted in management of higher risk patients in the OU. Following implementation, OU chest pain patients were older and were more likely to be hospitalized or diagnosed with MI.
评估病史、心电图、年龄、危险因素和肌钙蛋白（HEART）路径对观察单元（OU）使用影响的数据有限。本研究旨在确定 HEART 路径实施如何影响 OU 使用。
对一家学术医疗中心实施 HEART 路径前后 2 年（2012 年 10 月至 2016 年 10 月） OU 登记数据进行分析。纳入因胸痛而被安置在 OU 的成年患者。确定 OU 胸痛方案中安置患者的比例占 OU 总容量和住院率以及心肌梗死（MI）的比例。使用 χ2 检验比较实施前后的比例，使用 Mann-Whitney U 检验比较年龄。
在研究期间，纳入了实施 HEART 路径前的 1688 例胸痛患者和实施后的 1692 例胸痛患者。实施后，OU 中胸痛患者占 OU 总容量的比例从（57% [1688/2968]降至 43.6% [1692/3882]；P<0.001）。实施前的住院率为 10.4%（175/1688），实施后为 12.4%（210/1692）（P=0.07）。实施后更多患者被诊断为 MI（0.8% [14/1665] vs. 2.0% [33/1686]；P=0.008）。实施后患者的中位年龄更大（52 岁 [IQR：45-59 岁] vs. 54 岁 [IQR：48-64 岁]；P<0.001）。
HEART 路径的实施导致 OU 中管理更高危患者。实施后，OU 胸痛患者年龄更大，更有可能住院或被诊断为 MI。
