Sex and race differences in safety and effectiveness of the HEART pathway accelerated diagnostic protocol for acute chest pain
| Autor: | Simon A. Mahler, Kristin M. Lenoir, Jason P. Stopyra, Anna C. Snavely, Nella W. Hendley, Brian J. Wells, Chadwick D. Miller, Brian Hiestand, David M. Herrington |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Chest Pain medicine.medical_specialty Acute coronary syndrome Myocardial Infarction Subgroup analysis 030204 cardiovascular system & hematology Chest pain Logistic regression White People Article Decision Support Techniques 03 medical and health sciences Sex Factors 0302 clinical medicine Internal medicine Ethnicity North Carolina Odds Ratio medicine Acute chest pain Humans 030212 general & internal medicine Myocardial infarction Acute Coronary Syndrome Mortality Aged business.industry Hispanic or Latino Emergency department Middle Aged medicine.disease Health equity Black or African American Hospitalization Logistic Models Female medicine.symptom Emergency Service Hospital Cardiology and Cardiovascular Medicine business |
| Zdroj: | Am Heart J |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2020.11.005 |
| Popis: | BACKGROUND: The HEART Pathway is an accelerated diagnostic protocol for Emergency Department patients with possible acute coronary syndrome. The objective was to compare the safety and effectiveness of the HEART Pathway among women vs men and whites vs non-whites. METHODS: A subgroup analysis of the HEART Pathway Implementation Study was conducted. Adults with chest pain were accrued from November 2013 to January 2016 from 3 Emergency Departments in North Carolina. The primary outcomes were death and myocardial infarction (MI) and hospitalization rates at 30 days. Logistic regression evaluated for interactions of accelerated diagnostic protocol implementation with sex or race and changes in outcomes within subgroups. RESULTS: A total of 8,474 patients were accrued, of which 53.6% were female and 34.0% were non-white. The HEART Pathway identified 32.6% of females as low-risk vs 28.5% of males (P = 002) and 35.6% of non-whites as low-risk vs 28.0% of whites (P < .0001). Among low-risk patients, death or MI at 30 days occurred in 0.4% of females vs 0.5% of males (P = .70) and 0.5% of non-whites vs 0.3% of whites (P = .69). Hospitalization at 30 days was reduced by 6.6% in females (aOR: 0.74, 95% CI: 0.64–0.85), 5.1% in males (aOR: 0.87, 95% CI: 0.75–1.02), 8.6% in non-whites (aOR: 0.72, 95% CI: 0.60–0.86), and 4.5% in whites (aOR: 0.83, 95% CI: 0.73–0.94). Interactions were not significant. CONCLUSION: Women and non-whites are more likely to be classified as low-risk by the HEART Pathway. HEART Pathway implementation is associated with decreased hospitalizations and a very low death and MI rate among low-risk patients regardless of sex or race. |
| Databáze: | OpenAIRE |
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